1. World Health Organization
27 December, 2017
Module 9
FACILITY MANAGEMENT
WASH FIT

2. Overview The importance of leadership
How to manage, incentivise and value staff
The importance of patient and community engagement
Minimum staff required to provide adequate WASH services
The basics of accounting and managing a simple budget for WASH services
How to procure, manage and store supplies

3. World Health Organization
Group discussion
27 December, 2017
How are HCF managed in your country? Do HCF have the autonomy to make decisions? How are health care facilities financed? Are different types/sizes of facilities managed differently? Are there dedicated budgets for WASH?
Spend a few minutes discussing how HCF are managed, in general terms. This will affect how WASH services can be managed, including financing, budgeting, management processes, decision making etc.

4. How can you encourage people to access a health care facility?
World Health Organization
How can you encourage people to access a health care facility?
27 December, 2017
Think about quality of care, cleanliness, safety, infrastructure. Community engagement, leadership. Remember that clean facilities should be the responsibility of everyone. You need to change people’s attitude towards managing and maintaining services.

5. How to encourage people to access a facility
Create a clean, safe environment
Keep the facility
Visibly clean
Safe and with no risk of infection
Ensure staff are friendly, trustworthy and follow appropriate IPC procedures
Staff are motivated, incentivised to work
WASH services are maintained to appropriate standards
WASH FIT will help you to do all of these things!

6. Leadership
Leadership: A good leader who is enthusiastic and driven can make changes and improvements even when resources are limited
WASH focal person: There should a minimum of ONE person responsible for WASH and IPC services, who has a clear job description and is known by all staff

7. Motivate and value ALL staff
Leadership is the key to success
Motivate and encourage staff to do a good job and recognize good performance
Cleaners and support staff should be valued as much as clinical staff
Reinforce the idea of team work
All staff should have written job descriptions

8. Example HCF management structure

9. Best practices for organisation and management of staff
Each staff member should have a written job description: Divide up tasks according to job descriptions and the skills of available staff
Organogram written and visible to all
On-going training and professional development
Regular staff meetings
Motivate, encourage and value ALL staff-recognizing good performance and addressing poor performers

10. Trophy given to best performing ward and made visible to all
Incentivisation
Keeping a facility clean requires ALL staff to be involved
Try to empower and motivate staff
Incentivise staff to change their behaviour and recognise good behaviour from staff
Performance should be assessed according to job description
Recognize high performers and develop improvement plans for those that do not perform and/or impose penalties
Awards for best performing staff or wards
Trophy given monthly to wards/departments
Ranking system using traffic light system
Trophy given to best performing ward and made visible to all

11. 3 examples of encouraging change within facilities
Each ward is ranked according to three levels of service and the results posted at facility entrace
Patient feedback box – outside OPD department. Patients pick a piece of paper (green, yellow, red) according to the level of service received
Patient feedback box – patients can post feedback to specific staff

12. Sharing knowledge and experience
Organise learning exchange events
Staff to visit other facilities
Peer to peer learning exchange
Referral hospitals provide support to smaller facilities

13. Patient and community feedback
Patients and the community are a critical part of a HCF and their opinions should be valued
Ensure that everyone’s voice is heard: feedback mechanisms should be inclusive of people who are not able to read or write
Ideas for measuring patient satisfaction
Comment box at entrance to facility
Comment books at key places in the facility
Regular surveys
Community discussions, e.g. with patients in the waiting room

14. Examples of patient engagement
World Health Organization
27 December, 2017
This slide shows a variety of ways to get feedback from patients and the community, to understand if they are satisfied with the quality of services and for them to make suggestions for change. It is important that if such mechanisms are in place, the health facility tries to address the comments that are given, otherwise the process will be ineffective.
Traffic light scoring system outside maternity ward
Community discussion group
Comment box at entrance to facility

15. Become a “model” facility
World Health Organization
Become a “model” facility
27 December, 2017
Facilities in a district can compete with each other for recognition of success, to become a model facility
Chose criteria, e.g. number of indicators improved, biggest increase in number of patients
Rate facilities like hotels, e.g. 3 or 5 star
Award a prize to best performing facility, each year. Remember you can lose your stars if you don’t maintain the quality!
Encourage participants to come up with their own ideas here. What would work in the local or national context?
Star rating? Other system? What could they win other than a star? Is there a budget that could be used for this?

16. Remember - change comes from all levels
World Health Organization
Remember - change comes from all levels
27 December, 2017
High level leadership and governance
Ministerial support
Celebrity endorsement
District level support
Technical and financial
Commitment by all at facility level
Motivated managers
All staff (medical and non-medical) must be involved
Community engagement and trust
Provide opportunities for feedback
Everyone needs to be involved to make a facility clean and safe.

17. Organisation within the facility
Accounting and budgeting
Procurement
Managing stock

18. Basic accounting and budgeting
Having a budget for WASH is needed for managing services
Provides useful information for facility managers, administrators, donors and suppliers
A facility should be able to answer the following questions
How much money is spent on WASH on a monthly or yearly basis?
What is the budget for operation and maintenance?
What is the budget for provision of supplies?
Where does the budget come from? What are the mechanisms for raising more money?

19. World Health Organization
27 December, 2017
Role play
10 minutes Person 1: You are running a WASH FIT training and you have to convince the facility manager of the important of WASH in HCF Person 2: You are the facility manager and you think you have already got too much work to do. You are not interested in putting time and money into improving WASH
Take minutes for this exercise. Divide participants into small groups (e.g. 4-5 people). Ask someone to act as person 1 and someone to be person 2. The other members can watch and provide feedback. After minutes, bring all participants back together and discuss the results.

20. World Health Organization
Role play
27 December, 2017
10 minutes Person 1: You are the manager of the HCF and you have to explain the methodology of WASH FIT and the benefits of using it to your staff Person 2 & 3: You have never heard of WASH FIT before and you do not understand the approach. You ask person 1 many questions about WASH FIT to try and understand more.
Follow the instructions as for the previous example. If there is not enough time to do both exercises, just chose one.
After minutes, bring all participants back together and discuss the results using the questions on the following side.

21. Discussion
How did you find the role play? How was it to try to convince staff about WASH FIT? What problems do you think you will face when using WASH FIT in your facility?

22. World Health Organization
27 December, 2017
Sample monthly financial reports
To summarize all incoming and outgoing money for each month
This slide is optional and may not be relevant for all groups.

23. World Health Organization
Managing supplies
27 December, 2017
Proper procurement prevents:
Shortages
Surplices
Waste
Loss of supplies
Mismanagement (e.g. expiration)
Procurement should happen BEFORE supplies run out
Order in quantities that are regularly required
Requirements are based on records of previous consumption
Build a system for managing supplies into the WASH safety plan, including common spare parts for water and sanitation infrastructure
This slide is optional and may not be relevant for all groups.

24. World Health Organization
Stock inventories
27 December, 2017
The process of manually counting the number of each type of product present in the facility
Conduct regularly, e.g. once a month
Record in an inventory sheet
The quantity of products available should match what has been recorded as used
The inventory sheet helps the provider find where totals don’t match
Also allows you to monitor expiry dates of products in stock
This slide is optional and may not be relevant for all groups.

25. Management indicators (1)
WASH FIT is in place, implemented and regular monitored.
An annual planned budget for the facility is available and includes funding for WASH infrastructure, services and personnel which is sufficient to meet the needs of the facility.
A dedicated budget for the continuous procurement of WASH items (hand hygiene products, minor supplies to repair pipes, toilets, etc.) is available and sufficient to meet the needs of the facility
A protocol for operation and maintenance, including procurement of WASH supplies is visible, legible and implemented.
Regular (at least weekly) ward-based audits are undertaken to assess the availability of handrub, soap, single use towels and other hand hygiene resources.
An up-to-date diagram of the facility management structure is clearly visible and legible
All staff have a job description written clearly and legibly, including WASH-related responsibilities.
Adequate cleaners and WASH maintenance staff are available.
A continuous training program for facility staff is implemented and staff are regularly assessed on their knowledge and learning (minimum requirements include Hygiene, IPC) and have opportunities to continuously refresh and increase their skills
Management indicators (1)
ESSENTIAL
WASH FIT or other quality improvement/management plan for the facility is in place, implemented and regularly monitored.
An annual planned budget for the facility is available and includes funding for WASH infrastructure, services, personnel and the continuous procurement of WASH items (hand hygiene products, minor supplies to repair pipes, toilets, etc.) which is sufficient to meet the needs of the facility.
An up-to-date diagram of the facility management structure is clearly visible and legible.
Adequate cleaners and WASH maintenance staff are available.

26. Management indicators (2)
ADVANCED
A protocol for operation and maintenance, including procurement of WASH supplies is visible, legible and implemented.
Regular ward-based audits are undertaken to assess the availability of hand-rub, soap, single use towels and other hand hygiene resources.
New health care personnel receive IPC training as part of their orientation programme.
Health care staff are trained on WASH/IPC each year.

27. Management indicators (2)
ADVANCED
Facility has a dedicated WASH or IPC focal person.
All staff have a job description written clearly and legibly, including WASH-related responsibilities and are regularly appraised on their performance.
High performing staff are recognized and rewarded and those that do not perform are dealt with accordingly.

28. World Health Organization
27 December, 2017
Questions?