APPROACH AND METHODOLOGY
The Health System Strengthening Program will support hospitals in Bangladesh to implement 'clinical governance,' a codified system used in many developed countries to improve the standard of clinical practice, and provide in-kind contributions of key medical supplies.
As defined by the UK National Health Service, clinical governance is composed of five elements: practitioner education and training; clinical audit; clinical effectiveness; risk management; research and development; and openness. icddr,b will train medical directors and practitioners in clinical governance. Management protocols for the most commonly diagnosed illnesses in Bangladesh will equip new and emerging physicians with step-by-step references and ensure a minimum standard of patient care, while also allowing flexibility for experienced physicians to move off protocol when necessary.
Beyond clinical governance, the program also will address another critical constraint in Bangladesh's health system -- a lack of medical resources, particularly medications, consumables, and equipment. To address this need, AmeriCares will oversee the safe and effective delivery of donated medications and consumables. Leveraging its network of 150 pharmaceutical manufacturer donors around the world, AmeriCares' medical, logistical, and regional staff will oversee the appropriate allocation and timely delivery of medical aid to icddr,b and the participating hospitals. MedShare will oversee delivery of their gifts-in-kind to the network of hospitals providing complementary consumables and refurbished medical equipment. icddr,b will provide in-country logistical support to distribute the in-kind donations to each participating institution.
The program's platform is a network of 12 hospitals -- 6 non-government and 6 government -- that already participate in Bangladesh's national influenza surveillance project. Together with the Government of Bangladesh and the US CDC, icddr,b manages the network and each institution already houses a full-time icddr,b staff person, which will reinforce effective management across the network. This point person at each hospital will support the Health System Strengthening Program, including oversight of clinical governance implementation and of inventory and distribution of medical and pharmaceutical donations.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
Year 1 (September 2011-August 2012):
- Outreach to medical directors in 12 hospitals to obtain pharmaceutical formularies and other information on medication needs, hospital consumables, and equipment.
- Implement clinical governance system at first hospital.
- Distribution of $1.65 million of medical donations, as AmeriCares delivers two containers of medications and hospital consumables and MedShare ships one container of complementary consumables and refurbished equipment.
Year 2 (September 2012-August 2013)
- Evaluate outcomes and impact in first hospital.
- Implement clinical governance system in next five hospitals.
- Distribution of $2.70 million of medical donations, as AmeriCares delivers at least three containers of aid and Medshare delivers three containers.
Year 3 (September 2013-August 2014)
- Evaluate outcomes and impact in six hospitals where clinical governance system has been implemented.
- Implement clinical governance system in final six hospitals.
- Distribution of $3.45 million of aid, as AmeriCares delivers at least four containers and MedShare delivers three containers.
- Final project evaluation.
Program implementation will occur over three years, from September 2011 to August 2014. The primary program deliverables are:
- 12 participating hospitals develop clinical governance programs within three years: 1 hospital in year one, 5 hospitals in year two, 6 hospitals in year three. By the end of year three, the project will have trained 7,600 clinical staff and para-professionals at the 12 hospitals.
- 12 participating hospitals audit their care within 12 months of initiating clinical governance program, showing adoption of treatment protocols and improved infection control. Target percentage improvements will be developed following baseline surveys at each facility.
- A minimum of $7,800,000 worth of in-kind donations delivered to participating institutions.
Although Bangladesh's economy has been expanding at a rate of five to six percent for the past 15 years, it remains one of the poorest countries in the world (ranked 196 according to World Bank data). Half of the 12 participating hospitals and all of icddr,b's facilities provide charity or subsidized care and predominantly serve indigent populations. The patients of icddr,b's facilities in Dhaka are disadvantaged and impoverished, with 80 percent living on less than $2 per day.
Bangladesh is a success story by some health measures and is on track to meet UN Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health). However, quality of care is inconsistent, depending on a number of factors such as budget constraints, political will of a hospital's medical director, and training of physicians, nurses and other hospital staff.
In Bangladesh, two leading constraints preventing the provision of consistent care are the lack of formalized clinical practice guidelines and the dearth of residency programs for physicians and nurses. (Icddr,b manages the sole residency programs in the country, but is only able to accept 32 physicians and 32 nurses annually, so a significant gap persists).
SEEKING: Financial Resources, Media/Marketing Opportunities
The partners of the Health Systems Strengthening in Bangladesh project seek a partner to provide funding for the Clinical Governance component of this project. $1.9 million in funding would leverage training of 7,600 health workers at 12 participating hospitals and benefit approximately 5 million patients over a 3-year period.
OFFERING: Implementing Partners, Best Practice Information, Media/Marketing Opportunities
As an in-country implementing partner, icddr,b is a highly respected public health research institution with global reach, excellent monitoring and evaluation, and the ability to disseminate best practices worldwide. AmeriCares is a premiere medical gift-in-kind donor, effectively delivering aid to carefully vetted partners under tight auditing procedures. MedShare is a strong partner in its provision of additional donations. The media/marketing opportunities are excellent as the program will provide benefit to over 5 million individuals in the one of the world's poorest countries, but with a fast-growing consumer market.