COMPREHENSIVE PLAN FOR SCALE-UP OF OXYGEN , EMERGENCY & CRITICAL CARE IN ZANZIBAR - DPG-HEALTH MEETING WED 10TH FEBRUARY 2021 12.05PM MOHSWGC ...
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Comprehensive DPG-Health Meeting Plan For Scale-Up Of Wed 10th February 2021 Oxygen , Emergency 12.05pm & Critical Care In Zanzibar MoHSwGC, Zanzibar
Background • Oxygen and critical care are essential for health services • Children with pneumonia • Critically ill mothers • Trauma and surgery • Infectious diseases • Other Emergencies • Essential Emergency and Critical Care • Is the care for all acute / critically ill patients in all hospitals in the world • Includes screening, triage, monitoring, oxygen & IV fluids resuscitation, etc • This basic EM/critical care may often be missed in hospitals • Increasing effective coverage could increase the impact of oxygen and save many lives • Huge current interest in oxygen and ECC – could become a positive legacy of the current global situation
Oxygen in Tanzania and Zanzibar
• All Tanzania
• Oxygen Group & Sub-group of Case Mx and IPC Sub-committee met
several times in 2020 and conducted assessments and activities
• Led to development of a plan for oxygen scale-up and critical care
training, coordinated by MoH in June/July 2020
• Zanzibar
• Activities coordinated by MoH Zanzibar
• Facilitated by WHO with input by Dr Tim Baker, technical advisor
• Assessment teams from MoH, WHO, MSD Mainland
• Developed the Comprehensive Plan in January 2021
Activities in the Zanzibar Comprehensive Plan 1. Assessment of the Availability of Resources for Emergency and Critical Care A MoH/WHO team of clinicians and biomed. Eng. visited 13 facilities in Unguja and Pemba and assessed the availability of resources using a structured questionnaire containing clinical and biomedical indicators. Mapping of health facilities was done to include referral/district hospitals and primary health care facilities especially those that provide health services for pregnant mothers and children. 2. Assessment on availability of oxygen supply in Zanzibar The 13 health facilities were assessed by a team of biomedical engineers and clinicians from the Ministries of Health in Zanzibar and Tanzania Mainland to assess the availability of oxygen supply and use 3. Pulse oximetry in Zanzibar Data were collated from MoH/WHO Zanzibar visits to health facilities during mentorship April-Aug 2020 and the Oxygen Scale- up Assessment Sep 2020 4. Cost estimate of oxygen therapy in SARI (Severe Acute Respiratory Illness) Estimates were made of the cost of oxygen therapy in patients with a low-need for oxygen, high-need or need for mechanical ventilation based on cost information from MSD, APHFTA, and Tanzania Oxygen 5. Essential Emergency and Critical Care Training Plan A coordinated plan for training, supportive supervision and mentorship for improving emergency and critical care was developed. The long-term vision is that no patient in Zanzibar should die from a condition that essential emergency and critical care could prevent. Annex: Oxygen Therapy Job Aid Development of an oxygen therapy job aid for health-workers, modified from the original World Federation of Societies of Anaesthesia version.
Zanzibar Findings
1. Human Resources and training
• limited number of skilled, trained health-workers on optimum use of oxygen therapy
• gaps in clinical management of critically ill patients and provision essential emergency and critical care
• gaps in knowledge and practices for optimum oxygen therapy
• gaps in knowledge about operation and maintenance of equipment
2. Medical equipment and supplies
• there are a substantial number of broken oxygen concentrators and other equipment in health facilities
due to a lack of technical expertise, human resources and financial support
• lack of consumables and other medical equipment
• a lack of pulse oximeters in health facilities. Pulse oximetry gap = 120 oximeters.
• power supply can be irregular
3. Oxygen
• a shortage of oxygen production capacity and supply
• the demand for oxygen is higher than that supplied
• a lack of oxygen cylinders and manifold systems in health facilities
• Oxygen therapy costs approximately 0.23cents (USD) per litre (see next slide) *Findings*
Approximate cost of treating a patient with oxygen
$1,200.00
$1,074.00
$1,000.00
$800.00
$600.00
$400.00
$258.00
$200.00
$28.00
$0.00
Low-need High-need Mech Ventilation
* Treating a patient with a severe respiratory infection with oxygen costs approximately $28 if they have low-need (2L/min for 2 days),
$258 if high-need (10L/min for 5 days) and $1,074 if they need mechanical ventilation (30L/min for 7 days)Recommended implementation plan • A comprehensive plan to strengthen emergency, critical care services and oxygen supply & use in 15 health facilities in Zanzibar in two phases over a two-year period • Phase One (Jan-Dec2021) • Phase Two (Jan-Dec2022) • Total cost-estimate = $2.2 million USD
Phase One: Jan to Dec 2021 Upgrading six hospitals, rolling-out pulse-oximetry throughout Zanzibar and starting training plan. • Acute repair and maintenance of plants, concentrators and other oxygen equipment • Training, improved routines and job aids in Kiswahili for maintenance teams on operation and maintenance of oxygen machines and related equipment including plans for cascade training to users • Procurement of cylinders, improving distribution and transportation logistics for oxygen cylinder refilling in 6 hospitals in Zanzibar (Mnazi Mmoja, Kivunge and Makunduchi in Unguja and Abdalla Mzee, Chake-Chake and Micheweni in Pemba) • Procurement of oxygen concentrators, consumables, with secured power supply for the 6 hospitals • Procurement of 120 pulse oximeters
Phase One: Jan to Dec 2021 continued • Upgrading the oxygen plant in Mnazi Mmoja, Unguja • Training for health-workers at the 6 hospitals in identification of hypoxic patients and the optimal use of oxygen and essential ECC supplies, including training on essential emergency and critical care at basic and comprehensive levels, TOT for 16 senior health staff in one of the critical care centers in Dar Es Salaam or Zanzibar, Mnazi mmoja critical care unit and the introduction of job aids to improve oxygen use and other supplies in health facilities • Assessments of the burden of critical illness, the outcomes for critically ill patients, the increase in coverage of essential emergency and critical care and the use of oxygen and its impact on outcomes to inform future procurement as well as cost- effectiveness calculations.
Phase Two: Jan to Dec 2022
Upgrading remaining facilities, installing new oxygen plants, implementing
maintenance teams and employing clinical instructors
• Ongoing maintenance of plants, concentrators and other oxygen equipment
• Continued training and improved routines for maintenance teams on operation and maintenance of oxygen
machines and related equipment and establishment of mobile maintenance teams in Unguja and Pemba who can
provide on-the-ground mentorship, supervision and maintenance, including training engineers and equipping
hospital maintenance workshops with oxygen analysers and tools
• Additional procurement of cylinders, improving distribution and transportation logistics for oxygen cylinder refilling
• Additional procurement of oxygen concentrators and consumables, with secured power supply
• Installing an additional oxygen plant in Unguja and a plant in PembaPhase Two: Jan to Dec 2022 continued
• Continued training for health-workers in identification of hypoxic patients and the optimal use of oxygen and
essential critical care, and the introduction of job aids to improve oxygen use in health facilities
• Upgrading and installing mini-plants, manifolds and reliable oxygen supply to nine other health facilities in Unguja
and Pemba (total over two years = 15 health facilities with reliable oxygen supply)
• Increased contracting with commercial suppliers, leading to increased medical oxygen production
• Increased human resources and training levels of staff working with hypoxic and critically ill patients
• Overall strengthening of critical care services
• Employment of two clinical instructors which can create a bridge between Mnazi Mmoja Hospital and the SUZA
Medical School and establishment of systems for sustainable training and mentorship
• Assessments of the burden of critical illness, the outcomes for critically ill patients, the increase in coverage of
essential emergency and critical care and the use of oxygen and its impact on outcomes to inform future
procurement as well as cost-effectiveness calculations.Cost-estimate
PHASE ONE Cost Tsh Cost USD
Acute repair and maintenance of plants, concentrators and other oxygen equipment 92,000,000 40,000
Training and improved routines for maintenance teams 23,000,000 10,000
Procurement of cylinders, distribution and transportation logistics for oxygen cylinder refilling for 6 hospitals 287,643,520 125,062
Procurement of oxygen concentrators and consumables, with secured power supply for 6 hospitals 110,400,000 48,000
Procurement of 120 pulse oximeters for all facilties in Zanzibar 69,000,000 30,000
Upgrading oxygen plant in Mnazi Mmoja 285,329,375 124,056
Training for health-workers in identification of hypoxic patients and the optimal use of oxygen and essential critical care 216,200,000 94,000
Coordination, Monitoring and evaluation 150,420,000 65,400
Total Direct Cost 1,233,992,895 536,519
PHASE TWO Cost USD
Ongoing maintenance of plants, concentrators and other oxygen equipment 138,000,000 60,000
Continued training and improved routines for maintenance teams 23,000,000 10,000
Establishment and operation of mobile maintenance teams in Unguja and Pemba 450,000,000 195,652
Procurement of cylinders, distribution and transportation logistics for oxygen cylinder refilling for 9 facilities 431,465,280 187,594
Procurement of oxygen concentrators and consumables, with secured power supply for 9 facilities 276,000,000 120,000
Installing oxygen plants and manifolds and improved systems for maintenance 855,988,125 372,169
Increased contracting with commercial suppliers, leading to increased medical oxygen production 460,000,000 200,000
Continued training for health-workers in identification of hypoxic patients and the optimal use of oxygen and essential critical care 167,900,000 73,000
Increased human resources and training levels of staff working with hypoxic and critically ill patients 400,000,000 173,913
Employment of two clinical instructors and establishment of systems for sustainable training and mentorship 460,000,000 200,000
Coordination, Monitoring and evaluation 305,746,667 132,933
Total Direct Cost 3,968,100,072 1,725,261
TSh USD
TOTAL 5,202,092,967 2,261,780
➢ USD $500,000 USD for Phase One; USD $1.7million USD for Phase Two
➢ Total = $2.2 million USDComprehensive Plan For Scale-Up Of Thank you Oxygen And Critical Care In Zanzibar
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