	Ministry of Health
	Health Sector Reform Programme of Trinidad & Tobago Bringing Healthcare closer to you !

Eastern Regional Health Authority

First & Second Quarter Report

Re Business Plan 2000 / 2001

OPERATIONAL TARGETS

Status as at Mar 31, 2001

Activity #
Status

GENERAL:

1 Oral Health

An internal team is presently reviewing the ERHA’s draft decentralization plan. The Plan to be finalized by May 21, 2001.

Outreach program targeted for commencement in September 2001 in the Nariva/Mayaro and St. Andrew/St. David districts. Vehicles are being procured and staff recruitment finalized.

Client screening commenced in quarter. Actual procedures with a health promotion focus are scheduled to begin in September 2001.

2 Ambulance Services

EHS established at the four stations that include: Sangre Grande Hospital, Mayaro, Rio Claro and Toco. The system is performing satisfactorily.

3 User Fees

The various user fee initiatives (previous) are producing favorable returns.

New fee-based initiatives added and performing satisfactorily to date. These include Bronchoscopy and PHI inspection of off-shore platforms.

4 Radiology

Introduction of new services on hold. Awaiting completion of the "new" GP wing at the Rio Claro Health Facility.

Equipment and other arrangements relative to implementation already in place.

5 GP Services

Introduction of the new GP services on hold in Toco pending completion of the Toco Health Centre. Other activities relative to implementation such as additional staff recruitment are in progress.

6 Cervical Cancer Screening

Staff training issues still being ironed out. The ERHA team is working along with Dr. Swantson and Ms. Granderson of the Microbiology Department, UWI.

Efforts being made to commence the service in the third/fourth quarter given the various constraints.

7 Baby Friendly

Coordinating and Monitoring Teams have been meeting regularly. Training of staff and community personnel is in progress. Plans are on target to facilitate baby friendly certification in October/November 2001.

8 Lab Services

Microbiology services introduced in April 2001 as planned.

Equipment required for the introduction of the Biochemistry services are being procured. Consumables and reagents are already in stock.

9 Health Management

Letter of offer issued to preferred candidate. Awaiting response.

10 Primary Care Model

Action on this project was deferred pending outcome of the Primary Care Consultancy due to commence shortly by the Ministry.

11 Chronic Disease

Action plan developed and being executed. Pilot project launch scheduled for August 1, 2001.

12 Adolescent Health

No progress. To be reviewed in the next quarter.

13 PHCIDP

Very slow progress on the various projects owing partly to tardy payment patterns by PAU. Issue has been raised at various levels at the Ministry of Health.

There are indications from the Ministry that some contracts that were scheduled to commence this year such as Valencia and Coryal may be delayed for as much as two years.

Expected completion dates for projects already in progress:

- Cumana                       May 31, 2001

- Toco                           June 30, 2001

- Rio Claro                     July 17, 2001

- Matelot                       June 30, 2001

- Grand Riviere              June 30, 2001

- Matura                       June 30, 2001

- Biche                         June 30, 2001

- Brothers Road            June 30^th 2001

14 Sangre Grande Enhanced Health Centre / Sangre Grande Development Control Plan

Consultant’s contract was amended to integrate both projects. No further development since.

15 Medical Equipment

Equipment being received for Toco, Cumana and Rio Claro Health Centres. Tenders to be issued by PAU for other outstanding pieces of equipment..

16 Nurses Quarters

Funding options did not materialize. Meanwhile, minor works being done at the Cumana Quarters.

17 Extended Care Unit

The Project Manager is presently preparing the Scope of Works.

18 Power Generator – SFGH

Preventative Maintenance contract awarded.

19 IS/IT

Some equipment procured under the recurrent budget.

Non PSIP funding did not materialize.

Authority represented on MOH committee by Systems Analyst.

20 Public Board Meeting

Organizing team has been meeting. The PBM scheduled to be held on June 28, 2001 in Rio Claro.

21 Staff Activities

Staff Annual General Meeting held on December 13, 2000 as planned.

Annual Sports and Family Day scheduled for August 2001.

22 Home Care Nursing
Priority given to Chronic Disease Pilot Project. Home Care Nursing being reviewed.

23 Health Promotion

Restructure of Health Education section to be pursued following appointment of the Health Promotion Specialist.

Health Promotion Month Planning Committee in place. Plans in place for execution of April/May 2001 health promotion activities. Focus this year on Men’s Health.

24 Nursing Management

Advertisements published re vacancy for Nursing Manager. Unsuitable applicants. Deferred Until further notice.

25 Mental Health Services

Meeting scheduled for May 2001 with Ministry. Due to discuss the Authority’s role and expectations re service delivery.

FINANCE & ACCOUNTING

1 Accounts Department

Board-approved departmental structure implemented in January 2001 as planned.

2 Region-wide Accounting Operations

The F&A department is engaged in discussions with MMS Consultants on the subject.

3 Cash Management

The Roynet Electronic Banking System was installed in December 2000 as planned.

4 Purchasing System

A draft plan has been prepared aimed at restructuring the existing purchasing system. The merits of same being discussed with relevant personnel.

5 Motor Vehicle Loans
Completed draft with ERHA motor vehicle application forms. Consultations ongoing with the Comptroller of Accounts and VAT officials on the subject.

HUMAN RESOURCES:

1 Recruitment

Thirty persons recruited over the period. Recruitment efforts continue to fill the other key vacancies.

Working with the MOH re addressing critical shortage of certain categories of medical personnel.

2 Policies

The Ministry of Health has adopted an approach of standardization of policies among the RHA’s. A two-day workshop was held re development of Human Resource Policies. Other sessions are being arranged.

3 Training

Training Plan completed.

4 Staff Database

Awaiting IS/IT Manager and Ernst & Young Consultancy. The Ministry is in the process of recruiting an IS/IT Manager. In the meantime ERHA employees data maintained under Access software.

5 Pension Plan

Trust deed established.

6 ERHA Training Facilities

Renovations to the LRC to begin in third quarter.

QUALITY

1 Quality Management System

Risk Management Protocol developed for testing at the SGH.

Training proposal in support of the Quality Improvement System submitted to PAHO and approval received to conduct training in May 2001.

Two officers of the Quality department have been assigned to the Standards and Protocol Committee function respectively. A full committee is yet to be established. The Accreditation core committee is expected to be formed by May 31, 2001.

2 Quality Improvement System

Training for quality team leaders scheduled for May 2001. Improvement projects to be agreed at training forum.

3 Waiting Times

Strategies being developed for sustainable improvements.

4 Customer Relations System

The Customer Relations System at the SGH now fully established and functioning satisfactorily.

System for community services constrained by absence of the Quality Coordinator.

5 Risk Management

First phase (Sensitization) completed at the SGH.

Draft Assessment Protocol prepared for piloting. To form part of the Risk Management Consultancy.

6 Accreditation

RHA’s core committee established. Consultancy dates revised to April 2001.

7 Awards System

In progress.

8 PEP Policy

System implemented partially at the SGH and MDH.

Implementation of the community services system outstanding.

Reporting cycle to be finalized. Target dates to be revised but to ensure implementation by June 30, 2001.

9 TQM Training

In-house training conducted.

Awaiting start of the national programme that would facilitate training for all RHAs. Ministry to issue tenders for same.

NURSING

1 Community Liaision Unit

The National Standards and Protocol Committee presently preparing a discharge planning policy.

The Ministry’s Policy and Planning Directorate is scheduled to conduct an impact assessment of the CLU.

2 Nursing Models of Care

Models being discussed.

3 Nursing Research Protocol

National Nursing Research Officer appointed. National Protocol to be established.

4 Home Nursing Care

Target date to be revised.

5 Nursing Staff Shortage

Needs assessment document that includes recommendation on the way forward is being prepared.

6 Health Promotion

Ongoing.

7 Clinical Path

To be incorporated as part of the Accreditation consultancy work.

NARIVA /MAYARO:

1 Immunization Programme

Polio : 17% out of 20%

MMR/YP: 33% out of 25%

HIB: 17% out of 20%

2 HIV

All health centers in the Nariva / Mayaro area participating in the HIV perinatal transmission reduction program.

Actual uptake by clients to be determined.

3 Maternal Health

Cervical Cancer Screening : awaiting development of cytology services at SGH. Being done at the

Rio Claro Health centre, facilitated by the FPA.

4 Rio Claro Maternity Unit

The Unit is presently being renovated. Consultation being held with Ministry to determine way forward.

5 Child Health

The baby friendly initiative is in its early stages of implementation at the various Health Centres.

6 Communicable Disease

All Doctors and Institutions are reporting weekly.

All cases notified by TPHL and IVCD have been investigated and followed up.

7 Chronic Disease

(see item #11 under "General")

8 Oral Health

Plan finalized. Preliminary ground work being done at the schools.

9 (noted as item 12 in the Action Plan) Infrastructure - MDH

Installation of new radiology unit at the MDH: in progress.

Minor operating theatre :relocated as planned.

ST. ANDREW/ST. DAVID:

1 Child Health / Immunization

Baby friendly initiative at early stages of implementation at various Health Centres.

Immunization Program ongoing. Polio 49%, DPT: 50%, MMR: 66%, YF: 66%, HIB: 48%

2 Maternal Health

Anaemia in pregnancy

Teenage pregnancy

Cervical Screening: training for staff in progress. One session done at SGH. Ongoing training at Mt. Hope.

Baby Friendly: positive results from the communities. 30% of mothers solely breast feeding for first three months. 80% Nursing Staff attended Lactation Management program.

Births for St. Andrew/St. David: Total = 520, Still births =3, Total deliveries = 11

3 Chronic Disease

A detail equipment list prepared. (see also item #11 under "General")

4 Adolescent Health

Workshops on HIV/AIDS conducted in secondary schools at Valencia, Matura, Toco and Manzanilla. A total of 246 students participated.

Two community adolescent groups established in Toco and Coryal respectively.

Monthly meetings continue with Youth Health Committee.

5 Oral Health

(see item #1 in "General" section)

1650 food handlers registered. 442 approved.

235 Itinerant Vendors Kitchen inspected.

69 Schools inspected.

397 kg of animals slaughtered. 60kg meat condemned.

24 reports of communicable disease. 100% of the reports investigated.

7 Disaster Preparedness

Staff participated in workshop sessions facilities facilitated by NEMA.

8 Disease Surveillance

9 Health Promotion

The 4 Diabetic support groups continue with monthly meetings. New group to be established at Cumuto Health Centre.

All Well-weight management programs re started in March 2001 after a three months break. Current funding from PAHO sufficient to cover up to March 2001. Awaiting feedback re "New" proposal submitted for funding for program for period April 2001 to December 2001.

Reported increase of members engaged in physical activity.

10 Infrastructure

(See item 313 in "GeneraI" section for status on the PHCIDP projects).

Cumana Health Centre Services temporarily transferred to Toco Health Centre. Patients are being transported to Toco via ERHA shuttle service, with the exception of Thursdays when a Maxi Taxi is used.

Clinical services at Toco Health centre transferred to the Maternity Unit.

Grand Riviere Health Centre Clinical services transferred to Sans Souci Health Centre. ERHA shuttle service transports patients temporarily on Thursdays.

Matelot Health Centre Clinical services temporarily relocated to the Matura Community Centre.

11 GP Services

……………………..

12 Quantification of Arrears re Increment for Public Servants 1987-1995
75% worksheets have been audited.

13 Re-introduction of Incremental Credits to Public Servants
Staff reports forwarded to the Permanent Secretary for approval.

Activity #
Status

1 Surgery

No Infrastructure work undertaken

2 Medical Records

Space identified for the storage of inactive medical records. Refurbishment work to be undertaken.

Awaiting appointment of Medical Records Officer to pursue establishment of structure and career path for Medical Records Department. Also to collaborate with HR re formulation of job descriptions.

3 Infrastructure

Repairs to service drip stands and trolleys : Completed.

Provision of additional seating accommodation for visitors outside wards and in Out Patient Clinic: Completed.

Replacement for defective louver frames and missing louver blades on wards : 80% completed. Short louver frames being acquired to finish the work.

Installation of wall fans on wards: Completed.

4 Laboratory Services

(See item #8 in "General" section).

5 IT

Computer for Internet Service procured and installed at library. Awaiting printer from supplier. Also awaiting TSTT to install Internet system at library.

Two printers procured and installed in the Accounts and Ultra Sound Services respectively.

6 Policy

Policy re maintenance of Drip Stands, Trolleys and Wheel Chairs: To be determined.

OFFICE OF THE EXECUTIVE ASSISTANT

01.05.28

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Activity #	Status
	GENERAL:
1	Oral Health An internal team is presently reviewing the ERHA’s draft decentralization plan. The Plan to be finalized by May 21, 2001. Outreach program targeted for commencement in September 2001 in the Nariva/Mayaro and St. Andrew/St. David districts. Vehicles are being procured and staff recruitment finalized. Client screening commenced in quarter. Actual procedures with a health promotion focus are scheduled to begin in September 2001.
2	Ambulance Services EHS established at the four stations that include: Sangre Grande Hospital, Mayaro, Rio Claro and Toco. The system is performing satisfactorily.
3	User Fees The various user fee initiatives (previous) are producing favorable returns. New fee-based initiatives added and performing satisfactorily to date. These include Bronchoscopy and PHI inspection of off-shore platforms.
4	Radiology Introduction of new services on hold. Awaiting completion of the "new" GP wing at the Rio Claro Health Facility. Equipment and other arrangements relative to implementation already in place.
5	GP Services Introduction of the new GP services on hold in Toco pending completion of the Toco Health Centre. Other activities relative to implementation such as additional staff recruitment are in progress.
6	Cervical Cancer Screening Staff training issues still being ironed out. The ERHA team is working along with Dr. Swantson and Ms. Granderson of the Microbiology Department, UWI. Efforts being made to commence the service in the third/fourth quarter given the various constraints.

7	Baby Friendly Coordinating and Monitoring Teams have been meeting regularly. Training of staff and community personnel is in progress. Plans are on target to facilitate baby friendly certification in October/November 2001.
8	Lab Services Microbiology services introduced in April 2001 as planned. Equipment required for the introduction of the Biochemistry services are being procured. Consumables and reagents are already in stock.
9	Health Management Letter of offer issued to preferred candidate. Awaiting response.
10	Primary Care Model Action on this project was deferred pending outcome of the Primary Care Consultancy due to commence shortly by the Ministry.
11	Chronic Disease Action plan developed and being executed. Pilot project launch scheduled for August 1, 2001.
12	Adolescent Health No progress. To be reviewed in the next quarter.
13	PHCIDP Very slow progress on the various projects owing partly to tardy payment patterns by PAU. Issue has been raised at various levels at the Ministry of Health. There are indications from the Ministry that some contracts that were scheduled to commence this year such as Valencia and Coryal may be delayed for as much as two years. Expected completion dates for projects already in progress: - Cumana May 31, 2001 - Toco June 30, 2001 - Rio Claro July 17, 2001 - Matelot June 30, 2001 - Grand Riviere June 30, 2001 - Matura June 30, 2001 - Biche June 30, 2001 - Brothers Road June 30^th 2001

14	Sangre Grande Enhanced Health Centre / Sangre Grande Development Control Plan Consultant’s contract was amended to integrate both projects. No further development since.
15	Medical Equipment Equipment being received for Toco, Cumana and Rio Claro Health Centres. Tenders to be issued by PAU for other outstanding pieces of equipment..
16	Nurses Quarters Funding options did not materialize. Meanwhile, minor works being done at the Cumana Quarters.
17	Extended Care Unit The Project Manager is presently preparing the Scope of Works.
18	Power Generator – SFGH Preventative Maintenance contract awarded.
19	IS/IT Some equipment procured under the recurrent budget. Non PSIP funding did not materialize. Authority represented on MOH committee by Systems Analyst.
20	Public Board Meeting Organizing team has been meeting. The PBM scheduled to be held on June 28, 2001 in Rio Claro.
21	Staff Activities Staff Annual General Meeting held on December 13, 2000 as planned. Annual Sports and Family Day scheduled for August 2001.
22	Home Care Nursing Priority given to Chronic Disease Pilot Project. Home Care Nursing being reviewed.
23	Health Promotion Restructure of Health Education section to be pursued following appointment of the Health Promotion Specialist. Health Promotion Month Planning Committee in place. Plans in place for execution of April/May 2001 health promotion activities. Focus this year on Men’s Health.
24	Nursing Management Advertisements published re vacancy for Nursing Manager. Unsuitable applicants. Deferred Until further notice.

25	Mental Health Services Meeting scheduled for May 2001 with Ministry. Due to discuss the Authority’s role and expectations re service delivery.
	FINANCE & ACCOUNTING
1	Accounts Department Board-approved departmental structure implemented in January 2001 as planned.
2	Region-wide Accounting Operations The F&A department is engaged in discussions with MMS Consultants on the subject.
3	Cash Management The Roynet Electronic Banking System was installed in December 2000 as planned.
4	Purchasing System A draft plan has been prepared aimed at restructuring the existing purchasing system. The merits of same being discussed with relevant personnel.
5	Motor Vehicle Loans Completed draft with ERHA motor vehicle application forms. Consultations ongoing with the Comptroller of Accounts and VAT officials on the subject.
	HUMAN RESOURCES:
1	Recruitment Thirty persons recruited over the period. Recruitment efforts continue to fill the other key vacancies. Working with the MOH re addressing critical shortage of certain categories of medical personnel.
2	Policies The Ministry of Health has adopted an approach of standardization of policies among the RHA’s. A two-day workshop was held re development of Human Resource Policies. Other sessions are being arranged.
3	Training Training Plan completed.
4	Staff Database Awaiting IS/IT Manager and Ernst & Young Consultancy. The Ministry is in the process of recruiting an IS/IT Manager. In the meantime ERHA employees data maintained under Access software.
5	Pension Plan Trust deed established.

6	ERHA Training Facilities Renovations to the LRC to begin in third quarter.
	QUALITY
1	Quality Management System Risk Management Protocol developed for testing at the SGH. Training proposal in support of the Quality Improvement System submitted to PAHO and approval received to conduct training in May 2001. Two officers of the Quality department have been assigned to the Standards and Protocol Committee function respectively. A full committee is yet to be established. The Accreditation core committee is expected to be formed by May 31, 2001.
2	Quality Improvement System Training for quality team leaders scheduled for May 2001. Improvement projects to be agreed at training forum.
3	Waiting Times Strategies being developed for sustainable improvements.
4	Customer Relations System The Customer Relations System at the SGH now fully established and functioning satisfactorily. System for community services constrained by absence of the Quality Coordinator.
5	Risk Management First phase (Sensitization) completed at the SGH. Draft Assessment Protocol prepared for piloting. To form part of the Risk Management Consultancy.
6	Accreditation RHA’s core committee established. Consultancy dates revised to April 2001.
7	Awards System In progress.
8	PEP Policy System implemented partially at the SGH and MDH. Implementation of the community services system outstanding. Reporting cycle to be finalized. Target dates to be revised but to ensure implementation by June 30, 2001.
9	TQM Training In-house training conducted. Awaiting start of the national programme that would facilitate training for all RHAs. Ministry to issue tenders for same.

	NURSING
1	Community Liaision Unit The National Standards and Protocol Committee presently preparing a discharge planning policy. The Ministry’s Policy and Planning Directorate is scheduled to conduct an impact assessment of the CLU.
2	Nursing Models of Care Models being discussed.
3	Nursing Research Protocol National Nursing Research Officer appointed. National Protocol to be established.
4	Home Nursing Care Target date to be revised.
5	Nursing Staff Shortage Needs assessment document that includes recommendation on the way forward is being prepared.
6	Health Promotion Ongoing.
7	Clinical Path To be incorporated as part of the Accreditation consultancy work.
	NARIVA /MAYARO:
1	Immunization Programme Polio : 17% out of 20% MMR/YP: 33% out of 25% HIB: 17% out of 20%
2	HIV All health centers in the Nariva / Mayaro area participating in the HIV perinatal transmission reduction program. Actual uptake by clients to be determined.
3	Maternal Health Cervical Cancer Screening : awaiting development of cytology services at SGH. Being done at the Rio Claro Health centre, facilitated by the FPA.
4	Rio Claro Maternity Unit The Unit is presently being renovated. Consultation being held with Ministry to determine way forward.

5	Child Health The baby friendly initiative is in its early stages of implementation at the various Health Centres.
6	Communicable Disease All Doctors and Institutions are reporting weekly. All cases notified by TPHL and IVCD have been investigated and followed up.
7	Chronic Disease (see item #11 under "General")
8	Oral Health Plan finalized. Preliminary ground work being done at the schools.
9 (noted as item 12 in the Action Plan)	Infrastructure - MDH Installation of new radiology unit at the MDH: in progress. Minor operating theatre :relocated as planned.
	ST. ANDREW/ST. DAVID:
1	Child Health / Immunization Baby friendly initiative at early stages of implementation at various Health Centres. Immunization Program ongoing. Polio 49%, DPT: 50%, MMR: 66%, YF: 66%, HIB: 48%
2	Maternal Health Anaemia in pregnancy Teenage pregnancy Cervical Screening: training for staff in progress. One session done at SGH. Ongoing training at Mt. Hope. Baby Friendly: positive results from the communities. 30% of mothers solely breast feeding for first three months. 80% Nursing Staff attended Lactation Management program. Births for St. Andrew/St. David: Total = 520, Still births =3, Total deliveries = 11
3	Chronic Disease A detail equipment list prepared. (see also item #11 under "General")
4	Adolescent Health Workshops on HIV/AIDS conducted in secondary schools at Valencia, Matura, Toco and Manzanilla. A total of 246 students participated. Two community adolescent groups established in Toco and Coryal respectively. Monthly meetings continue with Youth Health Committee.
5	Oral Health (see item #1 in "General" section) 1650 food handlers registered. 442 approved. 235 Itinerant Vendors Kitchen inspected. 69 Schools inspected. 397 kg of animals slaughtered. 60kg meat condemned. 24 reports of communicable disease. 100% of the reports investigated.

7	Disaster Preparedness Staff participated in workshop sessions facilities facilitated by NEMA.
8	Disease Surveillance
9	Health Promotion The 4 Diabetic support groups continue with monthly meetings. New group to be established at Cumuto Health Centre. All Well-weight management programs re started in March 2001 after a three months break. Current funding from PAHO sufficient to cover up to March 2001. Awaiting feedback re "New" proposal submitted for funding for program for period April 2001 to December 2001. Reported increase of members engaged in physical activity.
10	Infrastructure (See item 313 in "GeneraI" section for status on the PHCIDP projects). Cumana Health Centre Services temporarily transferred to Toco Health Centre. Patients are being transported to Toco via ERHA shuttle service, with the exception of Thursdays when a Maxi Taxi is used. Clinical services at Toco Health centre transferred to the Maternity Unit. Grand Riviere Health Centre Clinical services transferred to Sans Souci Health Centre. ERHA shuttle service transports patients temporarily on Thursdays. Matelot Health Centre Clinical services temporarily relocated to the Matura Community Centre.
11	GP Services ……………………..
12	Quantification of Arrears re Increment for Public Servants 1987-1995 75% worksheets have been audited.
13	Re-introduction of Incremental Credits to Public Servants Staff reports forwarded to the Permanent Secretary for approval.

Activity #	Status
1	Surgery No Infrastructure work undertaken
2	Medical Records Space identified for the storage of inactive medical records. Refurbishment work to be undertaken. Awaiting appointment of Medical Records Officer to pursue establishment of structure and career path for Medical Records Department. Also to collaborate with HR re formulation of job descriptions.
3	Infrastructure Repairs to service drip stands and trolleys : Completed. Provision of additional seating accommodation for visitors outside wards and in Out Patient Clinic: Completed. Replacement for defective louver frames and missing louver blades on wards : 80% completed. Short louver frames being acquired to finish the work. Installation of wall fans on wards: Completed.
4	Laboratory Services (See item #8 in "General" section).
5	IT Computer for Internet Service procured and installed at library. Awaiting printer from supplier. Also awaiting TSTT to install Internet system at library. Two printers procured and installed in the Accounts and Ultra Sound Services respectively.
6	Policy Policy re maintenance of Drip Stands, Trolleys and Wheel Chairs: To be determined.