Northern Provincial Hospital

Overview

1. Roles and responsibilities

NPH is the designated referral hospital for Luganville municipality and SANMA Province. SANMA Province is divided into 9 health zones with designated health facilities and staff to provide primary care services and public health interventions to the coverage population. The health zone coverage area and their populations are represented below.

Figure 1. SANMA Province health zones and health facilities

Zone	Population (Population (2017 Projected population)
1	18,460
2	7,710
3	5,186
4	8,653
5	2,964
6	3,508
7	3,091
8	2,405
9	6,940
Total	58,917

NPH also assumes the role of provincial referral hospital for the four northern provinces of MALAMPA, PENAMA, SANMA AND TORBA. The catchment population is 140,977 (projected population in 2017) which is approximately 50% of the total population of Vanuatu. A summary of catchment population can be represented as such:

Table 2. Summary of NPH catchment area by sex (2016 Mini-census)

	Male	Female	TOTAL
MALAMPA	20,689	20,239	40,928
PENAMA	16,549	15,985	32,534
SANMA	27,901	26,283	54,184
TORBA	5,153	5,008	10,161
TOTAL	70,292	67,515	137,807

Table 3. Summary of NPH catchment area by age group (2016 Mini-census)

	<15 years	>15 years	TOTAL
MALAMPA	16,443	24,485	40,928
PENAMA	13,497	19,037	32,534
SANMA	20,765	33,419	54,184
TORBA	4,179	5,982	10,161
TOTAL	54,884	82,923	137,807

2. Governance

NPH has an established governance structure according to the PSC approved Ministry of Health structure for hospitals. There is a strong emphasis on an organisational framework and continuous assessment on activities through monthly Management, Heads of Section and Section meetings has steered our activities towards improved key outcomes. We recognize that communication of information through a bottom up approach is a key priority for a successful outcome.

Monitoring and evaluation of over-all hospital services and expenditure is provided by the Ministry of Health through its Internal Audit and Finance Unit. Additional support has been provided by technical advisors from the World Bank.

In 2016, NPH was identified as one of the premier public institutions and was audited by the parliamentary-appointed Public Accounts Committee.

3. Provincial

An established administration channel of communication and robust teamwork has allowed NPH to assist neighbouring provincial hospitals and provincial public health services with public health services planning, corporate planning and cost-sharing of priority activities, financial services and annual business planning, medical outreach services and specialist clinical services planning.

4. Community Service

NPH is dedicated to providing community services that benefit the wider community. These primary care services include providing medical services and training of first aiders during provincial and national sporting events. NPH promotes staff participation on national duties whether as an athlete, health officer or volunteer basis.

5. Public Health

NPH actively participates in public health initiatives such as public health awareness programs, outbreak response and integrated outreach visits. Delivering integrated health services is cost effective and addresses the root cause of morbidity and mortality.

6. Partnetships

NPH continues to promote private-public partnerships with various local and overseas-based organizations such as Aid In Kind partners (DAISI, NZ Doctors Sabbatical), Church Based Organizations (Churches of Christ Medical Santo, Wings of Hope, Marine Reach, Pacific Yacht Ministries), Non-Government Organizations (Motivation Australia), International NGO (Rotary, Global Fund, JICA, IsraAid) and development partners (DFAT, MFAT, WHO, World Bank, Unicef, UNDP). These partnerships are guided by standing MoU’s with the Ministry of Health and serve to strengthen hospital services and meet service gaps.

7. Mortality

The key health parameters to do with morbidity are summarized in Table 4 and 5.

Table 4: Top 5 causes of Death (Age 20 – 50 years) at NPH

Serial	Cause of Death	Remarks
1	Complications related to diabetes	Across all services
2	Complications related to hypertension	Across all services
3	Complications related to cardiovascular disease	Across all services
4	Complication related to Sepsis	Across all services
5	Malignancy	Across all services

Table 5: Top 5 causes of death (Age <1year) at NPH

Serial	Cause of Death	Remarks
1	Complications related to severe acute malnutrition	Data from Paediatrics Services
2	Complications related to congenital heart disease	Data from Paediatrics Services
3	Complications related to meningitis	Data from Paediatrics Services
4	Complications related to intrauterine hypoxia	Collected from Nursery services
5	Complications related to prematurity	Collected from Nursery services

Services Provided

Table1: Services Provided

Services Provided	Availability
Administrative Services
Administration	YES
Human Resources	YES
Finance Management	YES
Health Information Systems	YES
Hospital Supplies	YES
Switch Board	NO
Nursing Services
General Nursing Services	YES
Specialised Nursing Services
a. Midwifery Services	YES
b. Nurse Practitioner Services	YES
c. Nursing Anaesthesia	YES
d. Eye Care	YES
e. Ear, Norse and Throat (ENT)	YES
f. Operating Theatre	YES
Medical Services
Outpatient Department	NO
Anaesthesia and Intensive Care	NO
Paediatrics	YES
Obstetrics & Gynaecology	YES
Surgery	YES
Internal Medicine	YES
Ophthalmology	NO
ENT	NO
Accident and Emergency	NO
Radiology	NO
Pathology	NO
Mental Health	NO
Allied Health Services
Laboratory Services	YES
Medical Imaging Services	YES
Oral Health Services	YES
Pharmacy Services	YES
Dietetics	NO
Physiotherapy	NO

Maintenance Services	Availability
Maintenance Services	YES
a. Carpentry Services	YES
b. Electrical Services	YES
c. Plumbing Services	YES
d. Waste Management Services	YES
e. Motor Mechanical Services	YES
f. Gardening Services	YES
g. Medical Gas Services	YES
House Keeping Services	YES
Social Work	NO
Kitchen Services	YES
Laundry Services	YES
Transport Services	YES
Ambulance Services	YES
Security Services	YES
Biomedical Services	NO

Key Archievements

It is a pleasure to report on the 6 priority operational areas and the key outcomes that have directly enriched the quality and standard of services that NPH is able to deliver.

Priority Area	1. INFRASTRUCTURE
Key Outcomes	1.1 Completed renovation of two staff houses allowing emergency staff to reside near the hospital compound and reducing Emergency Response Times for surgical operations.
	1.2 Completed renovation of Tuberculosis and Medical wards addressing staff work environment, patient care, patient flow and infection control and prevention issues.
	1.3 Completed renovations of Paediatric ward addressing staff work environment, patient care, patient-flow and infection control and prevention issues.
Priority Area	2. HUMAN RESOURCE
Key Outcomes	2.1 Settlement of outstanding on-call allowance claims over twelve month period with a view to monthly settlements in 2018
	2.2 Settlement of outstanding Acting allowances with a view to permanent appointments in 2018
	2.3 Introduction of specialist locums for Obstetrics and Gynaecology, Anaesthesia, Internal Medicine and Surgery with a view to providing clinical supervision of interns, mentorship of registrars and allowing regular integrated provincial outreach visits.
Priority Area	3. STANDARD OPERATING PROCEDURE
Key Outcomes	3.1 Review of hospital nursing services Standard Operating Procedure manual with a view to implementation of the manual in 2018
Key Outcomes	3.2 Review of hospital financial services Standard Operating Procedure policy with a view to implementation in 2018
Priority Area	4. EQUIPMENT
Key Outcomes	4.1 Installation of hand-washing facilities and consumables for infection control and prevention; in all sections
	4.2 Maintenance of medical laboratory and medical imaging machines to ensure optimum function and support clinical services
	4.3 Acquisition of a paediatric bronchoscope to assist paediatric clinical services
	4.4 Instalment of computerized digital x-ray machine to assist clinical services and examinations for seasonal worker’s scheme


Priority Area	5. Outreach
Key Outcomes	5.1 Provision of integrated outreach services to TORBA, SANMA, PENAMA and MALAMPA
	5.2 Establishment of Emergency Medical Teams deployed to provide integrated clinical and public health services in Ambae Volcano disaster response
	5.3 Provision of community based first aid services to local, provincial and national events including Van2017 Pacific Mini-Games from December 4-14th to ensure safety of participants and spectators
Priority Area	6. Continuous Professional Development and Training
	6.1 Introduction of Medical Internship Program rotations to NPH as part of rural exposure, including participation in Emergency Medical Teams and Van2017 Medical Services
	6.2 Completion of VIPAM training skills series and graduation of NPH staff in BESS, CLDS and Filing and Confidentiality and specialist nursing areas of mental health and child health.
	6.3 Supporting staff to attend and present research papers at regional conferences in Port Vila e.g Local interventions for improving the management of Post-Partum Haemorrhage (PSRH conference, July 2017), Establishing Emergency Medical Teams (VMDA-GCMA conference, September 2017), Provincial Hospital Management - NPH (VMDA-GCMA conference, September 2017)

Objectives

Establish a functional management team for the hospital
Establish key planning documents
Strengthen Revenue Collection for Lenakel Hospital
Decentralize of clinical services to reach all population for TAFEA Province
Strengthen the workforce for the Hospital

Means of Services Delivery

Monthly managers meetings and working with Ministry of Health with aid donors
Managers work in line with ward incharge and general services to create a business plan for 2018
Appoint a staff on contract collecting revenue with the assistance from Finance officer assistance
Increase outreach Activity around Tanna and TAFEA Outer Island
Appointment for off books, contract and acting position in to the new structure