Women & Children Foundation Ltd, INDIA

Background: WCF (India) Limited was founded by group of Indian Doctors working for National Health Service (NHS) in United Kingdom. They started implementing NHS principles in Chennai, India in the year 2000. Their aim was to ensure that standardized, scientifically proven, equitable, healthcare available at an affordable cost and managed by free at the point of delivery. In support of this, WCFs goal is to search, develop and train healthcare professionals to provide high quality clinical services to people of developing countries, in India and abroad.

Hospitals and healthcare organization operation structure needs to improve to meet the Technological advancement, family financial availability and the disease load of the society. India, houses the largest middle income salaried population in the world. People in developing countries are deprived of a health system that prevent illness and empower them with knowledge and wealth. We are world expert in bye-pass surgeries than to prevent diabetes, hypertension and overweight & HIV infection. Politicians in the developing countries are designed to be in reactive mode and never in the Proactive Health Strategy mode. The equivalent analogy is Indian citizens are always in the running to catch a bus (which they may often miss) than be 5 minute early in the bus stand.

Modern Healthcare Corporate group of hospitals are world leaders and technologically ready to meet the tertiary care needs than to prevent cancer in the society. Majority of the hospitals adapt the current Americanized insurance lead care, which is fortunate gift for few of us, and the share holders. Even Americans cannot afford to provide quality assured equitable high tech care of its 250 million people. We all know that America is seven times larger than India, and many folds richer than India (financial and natural resources). With 4 times more population and is still growing will not be able to meet the global standards in 100 years to come? The down side will be more corruption in political world; robbery in the society and human loss in the family. Women and Children Foundation

The attitude of people towards health care is changing rapidly with improving economic performance of the World. There is an acute shortage of suitable and affordable service providers in the industry, especially for the masses. This opens up a valuable opportunity for an organization with right intension and resources to provide a valuable service to the community and also to be profitable. WCF not only intends to provide a holistic health care to the women and children but also to work in close partnership with the local community and takes care of family as a whole. The care must not only be curative but also preventative. The preventive health care (primary care) also includes creating awareness among the served population about the relevant measures of healthcare. On the long run the economic resources allocation and health professionals time spent will be optional with sustainable improvement in the quality. This is reflected in the organizational philosophy which keeps women at the centre of decision making in health about her family, her community & her country and Herself. Organizational Philosophy WCF is committed to a high quality (women centered) family friendly chain of hospitals. The service will be cost effective, comprehensive and delivered through non-judgmental trained health professionals. They will follow standardized prewritten proven high quality protocol. WCF will collaborate and work in partnership with local healthcare

providers, National and International health agencies. Mass community education and raising awareness in the prevention of illness is of high priority and we aim to develop strategies to use Television, advertising industry and local media effectively when and where appropriate.

Mission Statement

Providing a good quality, equitable and affordable health care, and is free at the point of delivery.

In line with the organizational philosophy stated above WCF has developed a comprehensive range of services, under a hub & spoke model , which not only serves women and children but also Local private practitioners Employers Local municipality Paramedical educational institutions Non-governmental organizations International health organizations.

The following table lists the services provided by WCF

Services offered by WCF

1. Womens Health

Primary Care

Well Women service/Preventive care HIV counseling and screening Sexual health counseling & treatment Social and environment victim care Teenage sexual health care & medical abortion.

Secondary Care

Institutional Maternity Care Infection in Pregnancy Office Gynaecology General Gynaecology General Medical & Surgical Care Laproscopic surgeries Gynaecology Oncology Service Perinatal Medicine Sub fertility Unit Reproductive Endocrinology Complimenting National Immunisation Children Nutritional & Growth surveillance School Health Service General Medical & Surgical Paediatrics Care of Special Needs Children Infectious Diseases Paediatric and neo natal intensive care Oncology Neurology Endocrinology Cardiology Multi lingual written materials Multi media programmes Cable and Television programme School & College education programme Business & Management support to Health care On site outreach primary care Occupational medicine

Tertiary Care

2. Childrens Health

Primary Care

Secondary Care

Tertiary Care

3. Health Promotion

4. Management Support 5. Industries 6. Local Practitioners Primary Care Secondary Care

Consultation and support services Consultation and support services Service utilization Blood Bank Laboratory and Emergency cover services Pharmaceutical support Telephone consultation to rural practitioners Prevention Cardiology Interventional Cardiology

7. Cardiology

8. Orthopedics 9. Resource centre

Trauma Joint replacement Public Library Creche and day care for staff and public Physical fitness centre Art & Culture centre Nursing Paramedics & Midwifery Medical Professionals Practical training centre for private colleges Professional development training for health Practitioners Under & Post graduate training Trained Ambulance Service Nursing & Medical trials Data collection for Clinical Audit Information support service Health Care research Statistical support to local practitioners

10. Educational

11. Emergency Services 12. Research & Audit

I.

INTRODUCTION One of the main policy trusts of the Health sector is to increase geographical and financial access to Health care and improve quality of care and efficiency of primary health services. As part of efforts to realize the global aim, the ministry of Health (MOH) has undergone considerable restructuring within the last five years.

One of the key objectives of Strengthening Health systems capacity in line with the overall goals of the Health Sector Reform Programme (HSPR), is to build a new District Hospital.

Whole Hospital Policies

Functions and Roles of the District Hospital The District Hospital is the form of clinical care at the district level, Each district hospital should cater for an average population of between 100,000-200,000 people in a clearly defined geographical area. The number of beds should be between 60-120. It is the first referral hospital and should be an integral part of the district health system-functioning to provide efficient, effective, affordable and equitable services of good clinical care and diagnosis, and supporting primary health services. A District Hospital Should: Provide curative care, preventive care and promotion of health of the people in the district. Provide skills and competence beyond those of the health centre and outpatient consultation: Treatment techniques e.g. surgery not available at Health Centres. Laboratory and other diagnosis techniques, appropriate to the medical, surgical, and outpatient activities of the district hospital. Inpatients care until the patient can ago home or back to the health centre. Provide training and technical supervision to heath centres and act as a resource centre for the health workers at each district hospital. Provide 24-hour service.

Provide the following clinical services.

Obstetrics and Gynecology Child health Medicine Surgery including anesthesia, as well as

 Accident and emergency service Provide paraclinical services Provide non-clinical support services Share in the district wide information gathering, planning, implementation and evaluation of health service programs. Act as a public reference laboratory for epidemiological surveillance and disease control at the district. Provide outreach services involving both static and mobile services. Provide referral services. It is to refer cases that are beyond its capability and skills to the nearest hospital that can safely perform the required service.

Services
1. Clinical services 1. A. Obstetrics and Gynaecology Emergency obstetric care Manual removal of placenta Vaccum extraction Caesarean section Provide reproductive health service Antenatal Deliveries ( normal and complicated/assisted deliveries) Postnatal Family planning Provide neonate care-including management of uncomplicated low birth weight, premature infant Prevention and management unsafe abortion and post abortion care. Diagnosis and management of basic gynaecological disorders including STD Pelvic inflammatory diseases

Ectopic pregnancies and HIV

Health promotion against harmful practices, e.g., female genital mutilation Cervical cancer screen Adolescent Reproductive Health Services (ARH) 1. B. Child Health Integrated management of common childhood illness-malaria, diarrhea , acute respiratory infection, malnutrition and measles. Health promotion and prevention Childhood immunizations (EPI) Health education Management of simple childhood accidents and injuries Management of common childhood diseases such as: Asthma Anemia Helminthiasis Tuberculosis Ear Nose and throat infection Skin disease Meningitis Cerebral malaria HIV/AIDS Sickle cell and other haemoglobinopathies Convulsive disorders.

1. C. Pediatric

Emergencies

 The unconscious child The very sick child Acute abdomen The child with convulsions Acute Respiratory distress Poisoning Animal bites Severe Dehydration and shock Severe Anaemia

1. D. Medicine
Diagnose and manage common infectious diseases including: STD Pneumonia Servere/cerebral malaria Tuberculosis Hepatitis Diarrhea Typhoid fever and HIV/AIDS Diagnose and manage common non-communicable diseases such as: Diabetes Anaemia Stroke hypertension Sudden collapse Heart failure Animal bites Management of common hereditary disorders e.g-sickle cell disease, asthma.

10

1. E. Provide simple mental health services such as: Depression Anxiety states Psychosis Seizure disorders Drug and alcohol abuse Each hospital should have inpatient care of mental patients. Perform simple medical procedures such as: Chest tube insertion Pleural fluid aspiration Abdominal fluid aspiration Lumbar puncture, etc.

1. Surgery
Perform simple operations and procedures: Acute abdomen conditions. Inflammatory conditions e.g. Appendicitis Obstruction of hollow organs e.g. strangulated hernia Perforation of hollow viscera e.g. Typhoid perforation Rupture of solid viscera Abdominal injuries Non surgical; causes of acute abdominal disorders Simple operations Herniorrhaphy Appendicectomy Lumps and dumps Incision and drainage Simple procedures

11

 Endotracheal tracheostomy Cut down Suprapublic cystostomy Ear Nose and throat Nose bleed Recognition of foreign bodies and their referrals Trauma and orthopaedic emergencies, Management of: Wound management

Fractures ( simple and compound fractures) Dislocations Hand infections Bone infections Join infections Burulli ulcer/or needed ) (specify epidemic for which isolation wards may be

Management of the accident /injures patient and mass casualty. Chest injuries Rib fractures Haemo and pneumothorax Others. Soft tissue infection Urological emergencies Trauma Kidney, ureteric, bladder, urethral, external genitalia injuries Non traumatic emergencies Infection of the : Kidney Bladder Prostate Testis Epidydimis

12

Haematuria, Acute retention of urine, Testicular torsion, Priapism, Phimosis, Calculi ( stones)

Burns : Resuscitation, first aid and wound management Pediatric surgical emergencies Intestinal obstruction Pediatric trauma Infections and inflammations of the abdomen Basic Eye Care Services Anesthesia 2. Dental services shall include General dental care Dental extractions, simple crowns and dentures Oral health education and promotion Screening, diagnosis and treatment of: Common oral health problems Dental caries and Gum infections

Minor oral surgery and procedures: Simple dental fillings, Simple crowns and dentures

Removal of retained roots Incision and drainage of dental infections/abscess Excision of dental cysts and soft tissue tumours. Basic dental radiology

13

3. Para clinical Services 4. A Laboratory/ Pathology Services Microbiology/parasitology Gram staining Culture and sensitivity testing of urine , blood, CSF, stool etc. Routine stool examination Routine urine examination Skin scrapping and snip ZN staining for AFB Vaginal and cervical swab Serology VDRL test Anti-streptolysin test Pregnancy test Viral serology Screening for HIV and Hepatitis B,C. Clinical Chemistry Blood glucose, GTT, urea and electrolytes, liver function tests CSF glucose, protein etc Faeces examination for occult blood Haematology Haemoglobin and red cell indices White cell count and differential and platelet count. Blood film for malaria and other parasites Erythrocyte sedimentation rate (ESR) Sickling test and Hb electrophoresis G6PD

14

 Bleeding and clotting screen Blood transfusion service Organize blood donation campaigns and collect blood. Collected blood should be sent to the regional blood centre for screening ( see below ) Collect screened blood and blood products from the regional blood centers. Blood grouping and cross matching Antenatal antibody screening and identification of antibody Coombs test Refer transfusion reactions to Regional Blood Centers. Pathological services Mortuary services Simple autopsies ( post mortems) Preparation of tissue specimens for histology Transportation of pathological specimens Gynaecological cancer (cytological) screening.

4. Imaging Services Mainly diagnostic Ultra sound and x-rays of limbs, skull, chest and abdomen, etc 5. Pharmacy Services Supplies management Preparation of extemporaneous preparation and dispensing Education and counseling patients Educating health professionals Ward/Clinical pharmacy Promoting health

15

 Research Drug information 6. Public health services Disease surveillance and Epidemic investigation and management Immunizations and preventive services Nutrition and Rehabilitation Health Information management Research and surveys Physiotherapy

7. Support services 8. A. Catering services for inpatients Provision of meals (breakfast, lunch and supper) to in-patients. Canteen services for staff and outpatients 8. B. Laundry services Central sterilization and supply services 8. C. Management and administrative services Medical administration Nursing and General administration

16

8. D. Environmental sanitation services Waste management Cleaning 8. E. Transport services Ambulance Stores and supplies Security service Maintenance service ( PPM) Estates Equipment

3. FUNCTIONAL ORGANIZATION
District Hospitals form an important link within the general Health Care Delivery system in the country in its primary role of providing health services for the sub urban populations of the district capital, as well as acts as a referral centre for complicated health problems from the various health centers in the district. A 100 bed District Hospital is being proposed to support the hierarchy services. This provision takes into account the population size, disease profile and resources to support an appropriate capacity and scope of services. The hospital will have the following departments: Out Patients Clinic & Emergency Ear, Nose and Throat (ENT) Ophthalmology Dental clinic

17

Diagnostics: Radiology / X-ray, ECG, Dental, Ultrasound Pharmacy Laboratory In-Patient Services General Wards ( medical and surgical) Maternity Reproductive Child Health (RCH) Surgery Central Sterile Supplies General Administration Laundry Maintenance Catering Mortuary Stores

The design should be based on the pavilion hospital concept. The individual buildings should then be interconnected by a system of covered walkways and payments. The main public car park should be located near the main entrance, within the hospital boundary. Sub parking areas and the mortuary. The hospital should have circular road surrounding it to provide individual blocks with vehicular access. District hospitals provide general hospital care and will usually be managed by 2-4 general duty doctors. Hence accommodation should be provided for key staff. At least 4 no.3- bedroom bungalow for the doctors + 5 no semidetached facilities -2 bed room each for matron , laboratory and x-ray technicians and nurses. Method of Delivery

The method in which the services stated above are delivered and marketed determines the success of the foundation as the whole. WCF recognizes this and has selected the following infrastructure and organizational structure, which will best serve its purpose.

18

Infrastructure

WCF Hospitals will be a 100 bedded unit, air conditioned & technological advanced health care to cater upper & middle income population of 5 Kilometer radius, across the capital of Ghana.

The 100 bedded units will be of 40,000 square feet, with Car and Ambulance parking. It will either be in purpose built or rental commercial space.

Service provider will be WCF and its staff with the following main specialties

Women Health Neonatal & Pediatrician Cosmetic Surgery General Surgery Cardiac surgery Laparoscopic Surgeries Orthopedic surgeries General Physician Surgical oncology Infectious disease Urology Diabetologist Alternative medicine

19

Organizational Structure The organizational structure of the Women and Children Foundation will consist of the director, who heads the business team and the service providers. New Capital Services Ltd will have one nominated member as a Director to take part in all business dealings. The business team will be responsible for the corporate planning, finance, human resources, quality assurance and training. There will be four different multidisciplinary professional departments. Each department will have pyramidal multidisciplinary structure in operation. Each team will develop its own objectives, functioning individually and in co-ordination with other teams. Team building is an absolute necessary for efficient functioning of this model as the workload is divided among the team members. The multidisciplinary team use time tested own protocols and guidelines, which enables the other members to function at their maximum potentials. Each department will have a team leader (consultant), junior physicians, nursing staff, technical staff and/or other necessary trained staff as required. Regular Quality auditing will be conducted and communicated to the multidisciplinary team.

Mode of Operation

WCF has developed a democratic model, which will enable each user feel ownership, the rights and cultivate the responsibility to influence the social decisions in the community for the well-being of society. A well-trained health professional will be leading each department. Medical and paramedical member will be recruited and trained to work for the Hospitals. Young junior health professionals who aspire to work towards the care of women and children will be encouraged. Pre-written, Quality tested, National Institute of Clinical Excellence (NICE) Royal College of Obstetrician & Gynecologist (RCOG), World Health Organisation (WHO) protocol and guidelines will be utilized for primary & secondary care. Research activities will need ethical approval. Regular teaching, training and audit meeting will be conducted by unit heads. WCF will integrate cultural and social events with health. Multimedia, television and local media will be effectively used to build up the community knowledge base in accessing the health care and protecting them from ill health.

20

Affordable, cost- effective financial packages have been developed which has proven to break the financial barriers in the middle income families. The package will be marketed, Monitored and refined by the research, audit and development team.

Example: 1. Mother & Baby Package 2. Hysterectomy 3. Laparotomy 4. Hernia 5. Cosmetic Surgery 6. Laparoscopic Surgeries 7. Cancer Surgeries 8. Heart Bypass 9. Hip replacement surgery 10. Cataract surgery 11. Women health Check-up` - $ 477/ - $ 577/ - $ 577/ - $ 577/ - $ 677/ - $ 777/ - $ 977/ - $ 977/ - $ 977/ - $ 277/ - $ 27/

The Market

This initiative will lay the foundation for WCF to establish similar projects all over West Africa. WCF and New Capital Services Ltd., will decide to locate the hospital in an established Regional health-care hub. In Chennai we have the successful model which is replicable and profitable in 12 months.

21

 Working women Majority of Chennai workforce has always been males but recent developments and the economic needs of the family have made many women to come out and work. The proportion of women in employment has increased rapidly, both in service and production sector.

This recent development has made women more independent and financially in a better position to seek effective healthcare, both in curative and preventive aspects. The provision of healthcare should be flexible enough and easily accessible. The mobile units of WCF, which will regularly visit the manufacturing facilities, schools and colleges, hope to achieve the same.

Pregnant Women The present care provided to pregnant women can be greatly improved by welltrained professional with proper access to supportive services like blood bank, neo-natal unit and intensive care unit. Women expectations have changed and they need more choice for safe delivery. Transmission of the infectious diseases like Hepatitis B and AIDS to the new born child can be prevented or reduced to a minimum by taking adequate measures during and after pregnancy. WCF will provide a specialized multi-disciplinary teamwork and institutionalized maternity care to meet individuals needs.

Adolescent children & Young adults Health education plays a vital role in preventive treatment of young people. Young people are sensitive to lots of the issues happening at this stage of the development. Young children under age 14 WCF would like to complement the existing system in improving the quality and quantity of immunization uptake. We aim to adhere to the World Health Organization recommendations and provide MMR (immunization against measles,

22

mumps & rubella) and Hepatitis B vaccine to school children who have missed out in the government schedule. School health surveillance with the aim to identify and provide care for children with special education needs. Premature Babies and Neonatal Up to 20% of the new born babies need specialist care and WCF will be able to meet such demands for babies who are 32 weeks or older. Mature women Two major killers, Ischemic heart disease and osteoporosis, in aged women, are curable. WCF intends to educate the population and encourage them to utilize the service provided by it.

Market Survey
In order to ascertain the suitability of the place a market survey must be conducted to learn more about the market and how WCF and the community can help one another. The main aim of the survey will be to determine the following Access to health care The attitude of local community towards Total health care services Preventive health-care Pre payment financial packages Health expense Family income Literacy in the community Advertising and Promotion As the concept and the product are new to the Ghana in which WCF is going to operate, advertising and marketing becomes critical for its success. People may be ready for preventive care, but the prepayment package is a radically new concept. So it becomes essential to clarify the benefits of this kind of packages to the population. After careful consideration it was decided the one to one selling would be the best way to gain customers for the prepayment packages during initial stages. This will be augmented by distribution of notices, letters, pamphlets and visit to local manufacturing facilities & educational institutions. Once WCF has become

23

familiar with local population advertisements through mass media will be given preference. Given the deep penetration of cable TV and TV in the region served they will form the main mediums of advertisements. In addition to the above, various cultural events with local celebrity will be conducted to not only attract people to WCF but also to educate the local population. Thus WCF will have a strong advertising and promotion campaign to promote its product & services. It will also establish WCF firmly in the community. In the next stage the representatives of WCF will encourage the private practitioners to use the facilities (Operation theatres, laboratories, clinical libraries, medical equipment, etc.); WCF has to improve their service. This will be the starting point of the partnership between WCF and Local service providers. The Public Relation department will act closely with local governing bodies, National and International NGOs to provide assistance in their local health care programs and clinical trials thus starting mutually beneficial relationships with them. Thus WCF would have firmly established itself as a major player in the society within 5 years of its establishment.

24