Recommendations, Conclusions [Review of Kam Pussum Hed (KPH) Clinic]

Recommendations from the Review, Conclusions and List of Annexes

5. Recommendations from the Review

To further strengthen the reproductive health services provided by the KPH Clinic, the review identified the following recommendations. Each key recommendation is directly linked to each of the main components of KPH covered in the review.

5.1 Physical Facilities

• To expand clinic space and facilities to accommodate increasing service demands and to introduce other services, as appropriate.
• To restructure the KPH premises so that the clinic area and the video room are located separately.
• To restructure the clinic area to include a waiting room, a storage area, equipment cleaning space and facilities, adjoining toilet, and other basic clinic facilities appropriate for RH health facilities.
• To assign a room for Peer Educators
• To assign a room for holding meetings and workshops with basic furniture and facilities.

5.2 Staff Training

• To develop standard guidelines and clinical protocols in the delivery of specific reproductive health services – such checklists for contraceptives and STI syndromic management.
• To conduct in-service training for clinic staff in reproductive health, including: counselling skills, contraceptive updates, STI management, application of the above guidelines and protocols, and clinic supervision and management.
• To establish mechanisms for on-going case reviews for staff and peer educators for sharing experiences and lessons learned.
• To review the referral mechanisms and establish effective referral networks with Vila Central Hospital.
• To arrange close collaboration with Vila Central Hospital through nurse monitoring visit at least once per quarter.

5.3 Community Education Programme

• To continue supporting the outreach programme, especially the community workshops and to make efforts to reach other communities not yet covered.
• Where possible, to incorporate video viewing and other forms of audio-visual approaches and IEC prints to enhancing the effectiveness of the community workshops
• To review coverage of communities and schools participation under the outreach programme with a view to expanding the coverage.
• To review target age groups for bus trips with a view to paying more focus on older students and teacher participation.

5.4 Peer Education Programme

• To continue to support Peer Education Programme
• To assign a peer education work-room under the proposed re-structuring KPH premises above.
• Review condom distribution through Peer Educators with a view to establishing a monitoring system to track condom distribution.
• For KPH Clinic to consider procuring its own condom supplies in the future, in view of increasing trends in use and the potential difficulty in securing regular supplies from Department of Health.
• To provide improved support mechanisms for on-going training and logistic support for the peer education programme. The support system will assist the work of the peer educators and also discuss their difficulties and challenges in doing community outreach work.

6. Conclusions

The review of KPH revealed important findings and key features of an NGO-based reproductive health facility for lessons learned and sharing of best practices in promoting access to reproductive health services to target groups. Given its relatively short history, KPH Clinic has made a significant breakthrough in attracting young people to access services from a community-based health facility. KPH is well known among both the young and the old as a place where they can easily access reproductive health services.

The model of KPH in having an IEC & community outreach programme that aims to deliver information to target groups on one hand, and a programme that delivers clinic-based reproductive health services on the other, is ideal in that one complements the other. The peer education programme, which works closely with the clinic staff, is a key factor to the promotion and utilisation of KPH services. Such a set-up ensures that the services and programmes appeal to the needs of communities. This is an ideal model and should be replicated in other communities and countries. In view of the success of KPH in running two parallel programmes, the review recommended that consideration be given to expanding another KPH-type of clinic in Port Vila. However, it is noted that this initiative involves resources and therefore priority should be given first to addressing the recommendations stated above to strengthen the current KPH operations before a second KPH Clinic can be established.

In order to share best practices and lessons learned from the KPH experience, it is important that KPH continues and further strengthens its linkages and collaborative work with government clinics, hospitals and other NGOs. Shared experiences will help to further improve the availability and accessibility of reproductive health services through resource mobilisation and better partnerships and striving for common goals and common vision.

6.1 Where is KPH now?

By the end of this year 2002, the KPH clinic would have been in operation for a total of four years. In those four years, it has surpassed all expectations. The original plans were for the clinic to provide information and clinic-based services for reproductive heath. A wider range of RH services are provided – the main ones being family planning & contraception, STI treatment and RH counselling. Information on RH through video and IEC materials are made easily accessible for clients while visiting the clinic. The video room has become very popular with the young people of the target communities. They would gather at the clinic to watch RH related videos being shown. Posters and pamphlets produced have been popular reading materials and feedback from the young people show that this information is being read and hopefully it has had some impact on their behaviour and lifestyles, and being acted upon.

6.2 What is the future for KPH?

All of the stakeholders believe that the KPH Clinic should continue to operate as an NGO-based RH facility meeting the RH needs of clients in communities. With KPH Clinic offering RH services, people living in the settlements close to it have found that they are now able to access the information and services that they were not able to access before. These services, as pointed out earlier, are also available at the Vila Central Hospital and the other Government clinics, but the population living around the KPH cannot always access that due to difficulty of transport etc.

As far as the nurses of the KPH are concerned, they would like the clinic to offer a few more services that are not currently offered. They would like to be able to do IUD insertion, pap smears and HIV testing. At the moment, pap smears cannot be done by the nurses because they have not had the required training to carry out the procedure. Both the nurses are keen to learn how to do pap smears so that they will be able to offer this service to their clients. STIs investigations such as taking specimen swabs are part of their daily work and they believe that pap-smear procedure is a similar approach. However, when introducing pap smears as a mechanism for cervical cancer screening, the need to secure good laboratory facilities at affordable cost to government should be considered. Furthermore, guidelines should be in place for the management of positive pap smears in terms of clinical management of cancer cases. It would be non-ethical to improve diagnostic screenings for cancer if they cannot be treated following laboratory diagnosis.

Some of the clients have been requesting that KPH Clinic introduces Voluntary HIV testing. At the moment, any KPH client requesting this test is referred to the Vila Central Hospital. Some of these clients would prefer to have this test done at the KPH and the nurses feel that it would be another service that they can offer their clients. However, it must be noted that HIV testing must have in place effective and efficient pre and post-test counselling services. Again national guidelines that address confidentiality and social responsibilities should be in place for dealing with positive cases.

7. List of Annexes:

Annex 1:Evaluation Training Programme

Annex 2:List of Participants in the Review Team

Annex 3:Review Process and Developmental phases

Annex 4:Evaluation Plan of KPH

Annex 5:Schedules of Review Data Collection

Annex 6:Clinic data: 2001-2002

Annex 7:Focus group discussions data

Annex 8:Data Collection Tools (9 Sets of Questionnaires & Interview Guides)