COMMITTEES OPERATING AT KCH

The following committees operate at Kamuzu Central Hospital The Hospital Advisory Committee The Central Hospital Management team The Heads Of Department Team 13 Cost Centre/Departmental Management teams The Budget Committee The Drug Committee The Blood Transfusion Committee The Internal Procurement Committee The Appointment and Disciplinary Committee The Staff Welfare committee The Medical Ethics committee The Institution Research Review Board The Housing Committee The Training committee The ICT Committee The Institutional Antibiotic Stewardship Committee The Tumour Board The Quality Improvement Support Team 28 Work Improvement Teams Institution integrity committee The Website Management Team The Maternal Audit Team The Hospital Liaison Committee The External Referral Committee

The HMIS committee The Emergency Preparedness and Response Committee The Medical Board

KCH PARTNERS

KCH is a facility owned by the Ministry of health and as such all collaborating Partners and Stake holders of the Ministry Of Health is also applicable to KCH. However KCH works very closely with the following stakeholders. University of Malawi College of Medicine and Kamuzu College of Nursing Malawi College of Health Sciences Lilongwe campus Dundee University St Gabbriel hospital Nkhoma Mission Hospital Mlare Mission Hospital Likuni Mission Hospital Daeyang Luke Hospital Lilongwe district Health office Dedza district Health office Nthceu district Health office Mchinji district Health office Kasungu district Health office Salima district Health office Nkhotakota district Health office Nthcisi district Health office Dowa District Health Office The Zonal Health Support office Central West

The Zonal Health Support office Central East Queen Elizabeth Central Hospital Zomba Central Hospital Mzuzu Central Hospital The Zomba Mental Hospital The Kamuzu Barracks Army Hospital The Red Cross The UNC Project The Lighthouse Baylor College of Medicine Haukeland University, Bergen and North Norway Cincinnati Childrens Hospital of USA Steve Biko Academic Hospital of SA Middlesbrough Hospital of UK John Cook Hospital of UK Friends of Kamuzu Central Hospital Airborne Health MASM Royal Australasian College of Surgeons, Royal College of Surgeons of Glasgow; Royal College of Surgeons of Ireland; Liverpool Gastroenterological Society; COSECSA COHSASA The Chitenje Trust JICA

UNDP GIZ CHAI MHEN CMST MBTS The ACB SMD Doctors Union Medical Association of Malawi Orthopedics Association Radiology Association Laboratory association Laundry Association Maintenance Association Mortuary Association Catering Association The Friedskorpt The Esther Magnet Project Baobab Trust The Pan African Network on E Health Appolo Health of India Artemis Health of India Spanish Hospital Italian Hospital Petroda

Tutla APPS Medical Council of Malawi Nurses and Midwives Council of Malawi Pharmacy Medicines and Poisons Board National Organization of Nurses and Midwives Lilongwe City Assembly All Registered Vendors Suppliers and Contractors The community The patient guardians The Diabetic Association The Kidney Foundation The Epilepsy association Staff

AWARD AND HONOURS

KCH CONTINUOUS QUEST FOR EXCELLENCE AWARDS
Infection Prevention Award 2007 to date Chosen site for implementation of APPS hand hygiene programme 3 star in SLMTA/SLIPT in laboratory services Pursuing quality improvement in RHU Pursuing quality improvement in Medicine Pursuing hospital wide Quality Improvement Programme accredited by COHSASA Accredited to train year 3 undergraduate medical students Accredited to conduct specialisation training in General Surgery and Orthopaedics under COSECSA

Our Centres of Excellence include Dialysis Unit Labour Ward

DONATIONS
KCH receives donations on annual basis from Itello from Sweden Lilongwe Rotary Club Bwaila CBM Africans in Diaspora Haukeland University Lord Provost of Edinburgh

ACADEMIC SECTION
KAMUZU CENTRAL SURGICAL RESIDENCY TRAINING PROGRAMME OF SURGICAL DEPARTMENT This Kamuzu Central Hospital (KCH) Surgical Residency Training program is an offshoot of a Memorandum of Understanding (MOU) between KCH/Bwaila Hospital and the Haukeland University Hospital of Norway signed in June, 2007 which provided for the academic, technological, equipment and manpower support to KCH. The late Dr. Hadji Juma saw the prospect of improving the Surgical Department of KCH with the assistance from this MOU. The request for assistance was met by an immediate positive response from a Norwegian Hospital triumvirate headed by Haukeland University Hospital (HUH). The Department of Surgery met with the counterpart from Norway a surgical collaboration was formed, drafting a document binding the partners to a common objective defining the responsibilities of each signatory. Areas of priority for the period 2008 2010 were identified upgrading the general surgical service with emphasis on Orthopedics and Pediatric Surgeries, improving theater management and performance, improving diagnostic capability (endoscopy & x-ray), trauma management and the long-term objective of establishing a surgical residency training program. A review of the programme was made by Norway in 2010 to evaluate the progress and impact of the program to the Malawi Health needs. The evaluation was highly favourable and recommended continued support. The funding commitment was then extended to cover until 2013 with option to extend to 2018. A separate MOU to cover the surgical collaboration was signed between KCH, HUH and Ministry of Health (MoH) in April, 2008. HUH in additional also represented two other hospitals in Norway involved in the programme, the University Hospital of Northern Norway and Ulleval University Hospital

The program officially started with Norwegian support in 2008. defined the responsibilities of each signatory which briefly are:

The

MOU

clearly

MoH will be responsible for the salaries for local staff and surgical trainees. KCH will provide the needed infrastructure and the accommodation of trainees. It shall also provide for expenses for local conferences/training. HUH will provide the monthly stipend for the trainees and expenses for any external training. It shall also provide academic and technical support. This would include visiting specialty faculty and teaching materials/books and IT. CPD for support services specifically theatre nurses will also be provided. HUH will also provide equipment and instruments for the theatre, orthopaedics and endoscopy services. In 2009, the University of North Carolina (UNC) also joined the collaboration. It will provide stipend to trainees and external training expenses. It shall also provide academic and technical support as well as equipment. A curriculum for surgical residency training was developed under the College of Surgeons of East Central and Southern Africa (COSECSA). KCH was accredited by COSECSA in Jan. 2009 for membership level. In June, 2011, application for accreditation of the training program to fellowship level was made and an accreditation team made its assessment of the program in August, 2011. Official result will be announced next month, September, 2011. There are currently 9 trainees under the program. Three are PGY3, 5 are PGY2 and 1 PGY1. The PGY3 will take their membership exams on the 7 th September, 2011. Six of the trainees are under the Norwegian support and 3 are under the UNC. Faculty is made up of resident consultant staff in the department with the assistance of visiting consultants from Norway, UNC and lately Surgical Societies and other international surgical institutions (i.e. Royal Australasian College of Surgeons, Royal College of Surgeons of Glasgow; Royal College of Surgeons of Ireland; Liverpool Gastroenterological Society; COSECSA) Currently, 50% of the resident consultant staff is United Nations Volunteers; 20% are ROC Aid; 10% VSO; 10% MoH and 10% CBM. In the past 18 months, we had 20 visiting consultants from Norway, UNC and other institutions; several have come two to three times during the period and have stayed more that 3 months at a time. Tangible improvements in infrastructure started with the program. Among others, the more significant are a more appropriate endoscopy area; expansion and improvement of the casualty and outpatient areas; the creation of an adequate library with facilities; pathology laboratory and the offices and quarters for trainees;

instrument washing area provided with automatic instrument washer in the theatre and the latest addition of a burn unit. Norwegian partners have provided up to date orthopaedic equipment and instruments; C-arm Xrays; gastro scopes for endoscopy and other surgical instruments. Maintenance services of these equipments are also provided by Norway. They also have provided consistent assistance to the library. UNC has provided a complete operational pathology lab and some library materials and IT subscription. The RCSG has gifted the program with an IT library, reading materials, computers and some furniture for the library The program has considerably upgraded the tertiary care delivery services in surgery at KCH. There are now established and accepted professional development activities for staff and trainees. Surgical knowledge and skills are enhanced for everyone in the department. Exchange of experience from visiting surgical specialists has a major impact on department staff and trainees. The programme helps KCH achieve its role as a tertiary care hospital. The visiting consultants are programmed to not only provide mentoring/training of residents but also for upgrading the skills of consultant staff in recent trends in surgery. Statistics show that more major cases have been performed in the past three years Patients are also given more attention with the supervision and follow-up of the surgical trainees. The future of the program sees about 15 residents at one time under training in the next two years. This will require additional facilities for service, teaching and training which mostly are in infrastructure. Below are the projected needs: a. Refurbishment of the present 4 major theatres. b. Additional two major and 1 minor theatres c. Improve radiology department including acquisition of a CT Scan d. Increase the bed capacity of the surgical service by 50% e. A conference room to accommodate at least 75 people f. Two smaller conference rooms for 30-40 people g. Offices for doctors orthopaedics and UNC offices h. Bigger area for quarters and office of resident trainees i. Upgrade/expand the endoscopy area j. Increase ICU beds to at least 8 k. Furnish 10 HDU beds. The progress achieved so far under this collaboration proved that a program like this can succeed with good coordination and cooperation of all partners and stakeholders. The current need for additional support to meet the requirements of the increasing number of trainees has to be addressed. The Government through

the Ministry of Health should take a more active role for the eventual assumption of taking full responsibility of the program.

The Ob-Gy residence programme under college of medicine The clinical officer bachelors degree programme The e-learning programme The internship programme Orientation of foreign health professionals before registration Orientation of undergraduates

CONFERENCES /WORKSHOPS AND CONTINUOS PROFESSIONAL DEVELOPMENT

KCH has organised the following conferences and training workshops for the year 2013 to 2014 Training workshop on advanced life support and anaesthesia, Department of Intensive Care and Anaesthesia KCH, venue Anaesthesia Training Centre KCH Date September 2013 Workshop on 5SKAIZEN-TQM, The Coordinator Quality Improvement Programme KCH Training Workshop in Trauma Management Training Workshop on oncology, Department of Medicine, oncology unit

Besides these activities KCH conducts activities that can earn points on CPD Grand rounds every Tuesday from 1200 noon to 2000 pm Venue UNC conference room Weekly Lectures in the Telemedicine Centre

E- HEALTH
Telemedicine documents from pratamnu

QUALITY IMPROVEMNET
In line with the HSSP and the vision of the hospital KCH management team staff and relevant stakeholders are implementing a quality programme in order to: Deliver world-class patient care through medical excellence Create a patient centred environment Ensure high standards and safety of treatment during the patients stay Continuous Quality Improvement through implementation of robust clinical and non-clinical process and protocols Having world-class infrastructure and cutting-edge technology utilised by highly skilled employees Complying with statutory regulations The hospital has been implementing QI programmes in IP, Laboratory Services Medical and Radiology department Over the years the hospital received recognition in IP and 3 stars in SLMTA SLIPTA QI programme in Laboratory Currently KCH has adopted a hospital wide quality improvement programme accredited by COHSASA with the aim of achieving hospital accreditation in 2017 REFORMS Decline in hospital services The MOH is responsible for a broad range of primary health care (PHC), preventive and curative health services. Through a referral system, which should commence at the PHC level, public hospitals are responsible for providing increasing levels of curative care. The availability and quality of curative services have been severely compromised due to: inadequate funding for the quantity and standard of services that public hospitals are expected to provide; extreme shortages of staff, especially skilled health professionals; HIV/AIDS which has increased demand for public hospital services, as well as taking its toll on public health staff; poor equipment and infrastructure related to inadequate investment and maintenance; and Under-management of public hospital resources, with the result that limited resources are not being used effectively.

Consequently, the MOH is faced with significant challenges to overcome barriers to cost-effective, efficient and quality hospital care. Under-management is of particular concern and is one of the underlying reasons for the creation of public trust hospitals. Hospital managers lack sufficient control over budgets, staff and

resources. The current centralised accountability paradigm makes it extremely difficult to hold public hospital managers accountable. Monitoring and appraisal of management are superficial, with few sanctions or incentives to encourage better and accountable performance. Progress to date In its 1995 Health Policy Framework the MOH identified hospital autonomy, meaning decentralisation of hospital management, as one of its original eight reforms required to improve efficiency and quality of public health resources without a corresponding shift in available resources. In 1997 an MOH Working Group on Hospital Autonomy prepared a draft policy which proposed goals and strategies for hospital autonomy, including the decentralisation of hospitals and new roles for hospital Boards, management and the MOH. The United States Agency for International Development has been providing assistance for the achievement of hospital decentralisation, including technical support from Partnerships for Health Reform from 1999 to early 2003 and from Management Sciences for Health and Health Partners Southern Africa since mid2003. In 2001 the Joint Implementation Planning (JIP) Committee, including Government of Malawi (GOM) and donor representatives, established a Hospital Autonomy Subcommittee to lead the implementation process. The Subcommittee agreed on a four-phase Roadmap and launched various planning initiatives, culminating in the development of this National Policy on Hospital Reform, completion of a Draft Constitution for a public trust hospital and oversight of activities aimed at strengthening management systems of central hospitals as part of the process of management reform. In July 2002 the GOM committed itself to the Malawi Poverty Reduction Strategy Paper (MPRSP) as its overarching statement of strategy providing the basis for future GOM activities and initiatives and a guiding framework for the GOMs development partners, both domestic and international. The four pillars of the MPRSP are (i) sustainable pro-poor economic growth; (ii) human capital development; (iii) improving the quality of life for the most vulnerable; and (iv) good governance. The MPRSP, along with the Millennium Development Goals (MDGs), has been the starting point for all health planning in Malawi. The MOH is acutely aware that a significant overhaul of existing health policies, legislation and procedures is required to realise the mandates in the MPRSP and MDGs, as well as the concurrent benefit of debt relief under the Highly Indebted Poor Countries Initiative. With respect to health, realising MPRSP and MDG objectives requires the MOH to rationalise and use existing health resources effectively in line with national health priorities specified in the MPRSP. MPRSP targeted areas, defined as Malawis national health priorities, include: providing preventive health care, including nutrition, water and sanitation and prevention of common diseases such as malaria;

providing community, primary and secondary health care under the essential health package; strengthening the referral system and introducing hospital decentralisation; and Promoting good nutrition.

All health policy initiatives must be designed to be consistent with the goals of the MPRSP and the Malawi Growth and Development Strategy, as well as the MDGs, and provide for public health generally. Further, compliance with the MPRSP is required for the GOM to qualify for debt relief under the Heavily Indebted Poor Countries Initiative. In recent years the term hospital autonomy has been associated inappropriately with concepts of privatization of state services, alienation of state assets, private health care, cost recovery from all patients and reduced access to central hospital services. None of these associations is envisaged as part of this National Policy on Hospital Reform, which is aimed primarily at improving the quality and efficiency of hospital services. Consequently, in March 2006 the MOH decided to stop using the term autonomy in favour of the more appropriate concept of hospital reform. Furthermore, the committee charged with implementing this process was renamed and reconstituted as the Central Hospital Reform Steering Commit tee.

KEY RESULT AREA Strengthen quality of care for the referral level patients of Malawi

ACTIVITY (1) Establish gateway clinics at Kamuzu Central Hospital * Identify a sturcture * Operationalise the clinic (2) Strengthen capacity of urban health central to provide comprehensive ambulatory care (3) Advocate for creation of District hospital in urban settings (4)Strengthen capacity of Central Hospital to provide quality tertially care

RESPONSI BLE PERSON

(5) Develop clinical guidelines, protocals, and user procedure manuals (6) Compile inventory of hospital equipment by area and status and improve infrastructure and equipment maintenance (7) Improve transport management system (8) Develop and implement service level agreements and performance management system (PAM,JICA) Improve use of public resources in an effecient, effective accountable and transparent way (1) Improve Central Hospital information systems including development of key performance indicators (2) Build capacities of cost centre managers focusing on accountability and responsibility Departmental Managers (3) Computerise accounting and financial systems (4) Standardise medical equipment systems (5) Improve personnel management systems (6) Improve security, storage and dispensing environment for BMS (7) Design and develop a computerised pharmacentical management system (1) Develop new revenue management system for tertiary facilities (2) Revise patient fees based on recosting of services and ability to pay (3) Establish guide lines for collection and for use of "user fees" and submit for approval by treasury (4) Refurbish private wards

Mobilise additional resources for tertiary level facilities

Create an enabling environment for improving quality of care and management in Central Hospital

(5) Develop and implement an incentive system to improve revenue generation (6) Inform public and hospital users about private wards (7) Initiate dialogue with private health insurance companies (8) Sign agreements with private health insurance companies (1) Use lessons learnt from the field to be used for evidence based decesion making with regard to hospital reform (2) Strengthen operational research to improve service delivery (3) Strengthen/develop networking with partner institutions within and outside Malawi to learn from each other (4) Develop a hospital reform policy (5) Advocate for implementation/communicati on on need for hospital reform with decesion makers, the public, staff etc. (6) Improve capital investment planning (offices, accommodation for staff etc) for Kamuzu Central Hospital (7) Advocate for sufficient funding and adequate HR for CH (8) Improve relationships between CH training institutions and Research centres in the interest of mutual benefit

KCH TEAM OF SPECIALITS AND CLINICAL HEADS Medicine Dr Jonathan Ngoma Dr Richard Nyasosela Dr Clara Schlaich Dr O. Punzo Surgery Dr Arturo Muyco Dr Carlos Valera Dr Svein Young Dr Leonard Banza Mr Nelson Msiska Paediatrics Dr Ajib Phiri Dr Rachel Mlotha Dr Hans Jorgeg

Obstetrics and Gynaecoloy Dr Grace Chiudzu Dr Ennet Chipungu Opthalmology Dr Joseph Msosa Dental Dr Jessie Mlotha Namarika Radiology Dr Suzgo Mzumara

Anaesthesia and intensive care Mr Onias Mtalimanja Laboratory Mr Henry Limula Physiotherapy Prosthetics and orthotics