Atlas Finds and then shares INNOVATIVE solutions to healthcare problems in low-resource settings

 

Practicing medicine in an under-resourced setting is challenging for any healthcare provider.  Successful healthcare provision must depend on partnerships, innovation, and thinking outside the box to use existing resources in a novel way.  ATLAS aims to work with its national partners to improve quality of patient care and to improve the lives of patients in creative and sustainable way.


the STATION SYSTEM

The Station System is a healthcare provision system meant to address the challenges of healthcare provision in under-resourced, rural clinic settings. Since it's creation in 2009, the Station System has undergone several changes and modifications to better suit the needs of the clinics that implement it.  To date, it has been successfully implemented in four health centers in rural Uganda.

 

What is it

The Station System and Outreach Program Model addresses the challenges of healthcare provision in under-resourced settings in a standardized and easy to replicate way.  Instead of focusing on a health center as a group of people treating patients, the model restructures the clinic into an operational system independent of the individual providers.  The model divides the clinic into specific Stations, each with clearly defined duties and expectations of the staff assigned to the Station, and patients follow a specific path through the Stations based on their initial triage.  Additionally, the model incorporates strong health outreach programming to reduce patient volume at the overburdened health centers, to increase awareness in the community about health and disease prevention, and to link the community to the health center as one functioning unit.

Station 1, Manafwa, 2013 (photo credit Douglas DaSilva)

Station 1, Manafwa, 2013 (photo credit Douglas DaSilva)

 

Primarily, the Station System model aims to rearrange what already exists at most rural health centers to better use existing resources.  When resources permit (i.e. with private health centers), new equipment, furniture and staff may be incorporated into the model’s implementation.  However, the goal is to implement the Station System with as little extra cost to the health center as possible.  This is accomplished by evaluating staff, supplies, and administrative procedures and making necessary recommendations and/or adjustments. 

 

 

how does it work

  • Division of the clinic into discrete areas, called "Stations,"
  • Clear expectations and duties for each Station,
  • Assignment of staff members to Stations appropriately matched to their skill set and expertise,
  • Assignment of volunteers or lesser-trained health workers to certain Stations,
  • Appropriate task shifting to maximize the time of more highly-trained staff,
  • Triage to provide care to the sickest patients first,
  • Division of remaining patients into more or less difficult cases,
  • Mandatory taking of vital signs and physical examinations at certain stations,
  • Incorporation of patient education and preventative care into each Station,
  • Routine review of health maintenance items for every patient regardless of their presenting complaint, and
  • Completion of an exit interview for quality assurance and control.

 

Station 5, Manafwa, 2013 (photo credit Douglas DaSilva)

Station 5, Manafwa, 2013 (photo credit Douglas DaSilva)

 

forms and tools

Each Station has a set of forms and tools meant to quicken non-clinical work and to circumvent the inefficient administrative tasks inherent to running a clinic without computers, electricity nor enough personnel and supplies.  Some of these forms are government forms or adaptations of government forms, and many are specific for the Station System model.  These forms can be adapted as needed for the particular clinical site’s needs and goals.

 

Staff education

A health center is only as good as the safe practices of its staff, and the Station System cannot be implemented if staff are not well trained or have no access to ongoing education.  The model should improve efficiency at a health center and create work policies (such as regular working hours) in order to secure time for clinician and health worker education.  At the initial implementation of the Station System, the healthcare team will meet for regular meetings to learn about, prepare for and adapt the Station System for their particular health clinic.  These meetings lay the foundation for future meetings that can focus on continuing medical education, setting practice and treatment guidelines, and reviewing the progress of the Station System.  A major goal of the Station System is to empower the health workers at rural sites to make connections with their partner sites, seek out educational opportunities, and create practice guidelines by which all health workers at the site agree to deliver medical care.  Only then can the model sustain and flourish.

 

Interested in the station system?

The system designed by Dr. Lisa was meant to help improve operations at existing health centers or to guide the planning for a new health center; many foreign based non-profit organization have the desire to set up a clinic in Uganda but not necessarily the know-how. The system is intended to be easily replicated and implemented.  If you are interested in discussing implementing the Station System at your health center, please contact us here.


OUTREACH PROGRAM: Taking the clinic to the community 

Dr. Elizabeth, Dr. Kristina, and MS4 Ashton, MCW, teaching basic health topics, Manafwa, 2016 (photo credit Ashton Schwerin)

Dr. Elizabeth, Dr. Kristina, and MS4 Ashton, MCW, teaching basic health topics, Manafwa, 2016 (photo credit Ashton Schwerin)

The outreach portion of the Station System model incorporates the education of the community both at the health center and from within the community itself.  Primarily, this is accomplished by finding dedicated, willing local volunteers from the communities surrounding the health center to take on the rolls of community educators, clinic volunteers, and patient advocates. 

Depending on the financial constraints of the organization operating the clinic, community volunteers participating in the outreach program can receive periodic (monthly, quarterly, etc.) non-monetary appreciations, such as food and household goods.  Typically, this periodic appreciation, if delivered, and the start up needs are the only costs inherent to operating the outreach program at a health center.

Just as with the clinical Station System model, each component of the Outreach Program has forms and tools used to facilitate the work of the outreach teams.  All tools can be adapted to the particular needs and goals of the site.  As the programs are implemented, the healthcare team, community volunteers and local stakeholders will meet frequently to learn about, discuss and adapt the programs to the particular needs of the health center and community.

 

 

Health education curricula

Education is the single greatest tool we have to combat illness in rural Uganda.  To ensure that the information to be disseminated to a community is correct and in accordance with Ministry of Health guidelines, we designed several standardized curricula meant to address the educational deficiencies within health centers, communities and schools.  Curricula usually include visual aids, review/discussion questions and activities, and they are designed to be either a verbatim teaching guide for lesser-trained health workers/volunteers or a suggestion to higher trained health workers/volunteers for how to deliver the information.  Whether we teach at schools, at the clinic, at community meetings, or to the staff, we keep these curricula as the foundation of all the education provided.  It is from these lectures that health workers can “Prescribe Education” sessions to their patients at the clinic.  

 

 

Village Health team "plus" program

Dr. Traci Downs, SUNY, teaching VHT members from health curricula, Manafwa, 2013 (photo credit Lisa Umphrey)

Dr. Traci Downs, SUNY, teaching VHT members from health curricula, Manafwa, 2013 (photo credit Lisa Umphrey)

New VHT-Plus training sessions, Manafwa Distract, 2013 (photo credit Douglas DaSilva)

New VHT-Plus training sessions, Manafwa Distract, 2013 (photo credit Douglas DaSilva)

The backbone of the outreach program is the presence of a well-trained Village Health Team (VHT).  VHT members are respected representatives from the villages surrounding the health center, selected by the local community and/or health center officials, to promote and support health education.  They serve as the health point-contact in their communities, and their duties include education provision, community mobilization, referrals to the health center, and often treatment of basic health conditions.  To become VHT members, volunteers complete a Ministry of Health training; District Health Educators (DHE) can usually prepare for and lead training sessions to either train trainers or train VHT members.   

To augment the Ministry of Health VHT Training for the Bududa and Manafwa districts, we created the "VHT-Plus" Training.  This allows our community health workers to go beyond the usual job description of a VHT member by learning how to take vital signs, better identify and refer sick patients to a health center, and even volunteer for a post in the Station System at their associated clinic.

VHTs and ATLAS volunteers, along with friends from HELP International, completed the RUMPs course, Manafwa, 2013 (photo credit Lisa Umphrey)

VHTs and ATLAS volunteers, along with friends from HELP International, completed the RUMPs course, Manafwa, 2013 (photo credit Lisa Umphrey)

rumps

Like in many places in Africa, girls are often unable to attend school while menstruating due to lack of sanitary supplies.

Peace Corps volunteers in Uganda developed the “Reusable Menstrual Pads” (RUMPs) course, which includes an adolescent and women's health lesson as well as the knowhow to make cheap and easy RUMPs.

ATLAS volunteers and VHT members can conduct educational sessions and outreaches to teach the RUMPs course to members of their community, promoting knowledge about women's reproductive health. 

 

INTERESTED IN THE OUTREACH PROGRAM?

Contact us here if you would like to discuss how to implement our outreach model at your health center.


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