The Swachh Bharat Abhiyaan launched by the Prime Minister on 2nd October 2014, focuses on promoting cleanliness in public spaces. Public health care facilities are a major mechanism of social protection to meet the health care needs of large segments of the population. Cleanliness and hygiene in hospitals are critical to preventing infections and also provide patients and visitors with a positive experience and encourages moulding behaviour related to clean environment. As the first principle of healthcare is “to do no harm” it is essential to have our health care facilities clean and to ensure adherence to infection control practices. Swachhta Guidelines for Public Health Facilities are being issued separately. To complement this effort, the Ministry of Health & Family Welfare, Government of India is launching a National Initiative to give Awards to those public health facilities that demonstrate high levels of cleanliness, hygiene and infection control.
Government of Karnataka in the footsteps of the center and with technical support from National Health System Resource Center(NHSRC), New Delhi has implemented the Swatchatha guidelines in 20 District Hospitals from May to October 2015. For 2016, the programme is set to be implemented in all District Hospitals, Sub-District Hospitals, Taluk Hospitals, CHC and PHCs across the State.
i. To promote Cleanliness, Hygiene and Infection Control Practices in public Health Care Facilities.
ii. To incentivize and recognize such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control.
iii. To inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation. iv. To create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes.
The awards would be distributed based on the performance of the facility on the following Themes :
1. Hospital / Facility Upkeep
2. Sanitation and Hygiene
3. Waste Management
4. Infection Control
5. Support Services
6. Hygiene Promotion
Criteria for Application to the Awards Scheme:
Following are the prerequisites for applying for an award :
1. Constituted a Cleanliness and Infection Control Committee.
2. Instituted a mechanism of periodic internal assessment/peer assessment based on defined criteria.
3. Achieved at least 70% score in the criteria during the peer assessment process.
Selection of Facilities:
The awards for individual public health facility will be given to those that score the highest based on a set of defined criteria. There will be three sub categories :
(a). Best District Hospitals : In every state the two top ranked district hospitals will receive an award. The first and second best district hospital level facilities will receive cash award of Rs. Fifty and Rs.Twenty Lakhs respectively.
(b).Best CHC/SDH Award : - In every state, the top two ranked CHCs / SDHs will receive an award. The first and second ranked CHCs/ SDHs will receive cash awards of Rs. Fifteen and Rs. Ten Lakhs respectively. For small states there will be only one award for the best facility in this category.
(c).Best PHC Award : In every district, the best PHC (24x7) will receive a cash award of Rs. Two Lakhs.
(d)In order to motivate, sustain and improve performance in facilities that score over 70%, but do not make it to the list of top two/one in a particular year, a Certificate of Commendation plus cash award would be given as follows :
(a) District Hospital - Rs. 3,00,000/-
(b) CHC / SDH Rs. 1,00,000/-
(c) Primary Health Centers Rs. 50,000/-
75% of the cash award amount will go to the Rogi Kalyan Samities for investments in improving the amenities, upkeep and services, while 25% of the cash award will be given to the facility teams as a team incentive.
State Level: A state level Award Committee is to be constituted under the chairpersonship of the Health Secretary/Mission Director. Suggested members include senior officers from Health Directorate, State Quality Assurance Committee, Development Partners working in the states, Superintendents of Medical College hospitals, NGOs working on health and sanitation themes, and representatives of other relevant departments like Public Health Engineering Department, Pollution Control Board and Water and Sanitation department.
The Terms Of Reference of this committee would be to:
1. Disseminate the criteria and methodology of this National Initiative to public healthcare facilities in the state.
2. Constitute state level external assessment team for the purpose of facility assessment and scoring.
3. Enable training of external assessors on the defined criteria.
4. Coordinate the process of assessment and validation of internal scores.
5. Finalize the list of award winners and runners up based on the assessment.
6. Facilitate an award ceremony at the state level and transfer award money to the respective facilities.
7. Resolve any conflict during the nomination and assessment process.
External Assessment Teams: External Assessment team would be constituted for the proposed assessment and validation of the scores of nominated facilities. State Award Committee would identify and appoint external assessors. Following can be appointed as External assessors :
1. State Level Program Officers/Officials from Directorate of Health.
2. Experts working with Developments Partners/International Agencies/NGOs.
3. Trained Internal and External Assessors for National Quality Assurance Standards/other quality standards.
4. Faculty from Medical Colleges/SIHFWs/Technical Support Institutions.
5. Retired Senior Health Officials and other Health Experts.
Each team would consist of three assessors, of which one would be an independent expert who is not from the government. For small states, one assessment team would be adequate. For larger states one assessment team can be constituted for 5-10 districts, say at each divisional level. External assessors at state level would be trained in using the assessment tool by NHSRC/NIHFW.
District Level Award Nomination Committee: A Three to Five member committee at the district level under the chairpersonship of the DM/Chief Medical Officer (CMO). Suggested members include CMO/representative, Member of Zilla Panchayat Health Committee, District Quality Assurance Committee, civil society representatives and eminent RKS members as members of which at least one of the members should be a woman. This committee would undertake the following tasks:
1. Disseminate details of award scheme and criteria to all health care facilities in the district.
2. Ensure the process of internal and peer assessment in the district through:
* Training facility staff in undertaking internal/peer assessments.
* Allocation of teams for peer assessments and providing logistic support.
* Monitor implementation of internal and peer assessments, and
* Review of scores and support facilities to fill identified gaps.
3. Nominate facilities for award based on the scores obtained by Internal/Peer Assessment for finalization at the state level.
National Level: At the national level, a National Committee under the Chairpersonship of the AS & MD, would review this National Initiative periodically for any necessary modifications.
Internal Assessment: At the beginning of the financial year, each facility should be assessed, scored and documented (including photo documentation) by its own staff using the assessment tool. Based on this assessment, the facility should identify the gaps and prepare an action plan to address these gaps. This internal assessment should be carried out every quarter and facility should maintain a record of scores for each quarter, which should also be submitted to the office of the Chief Medical Officer.
Peer Assessment: For those facilities that have an average of 70% score on internal assessment, the state/district will ensure that Peer Assessment is carried out. Peer validation of a score of 70% and above is a criterion for application for the award. Within the district, hospital staff of one block level facility would undertake the assessment of a facility in another block.
This would be determined by the DHS/CMO. At the state level, a similar process would be followed within the state allocating a team from one DH to travel to another DH to undertake an assessment. The peer assessment should be done at least once in a year for all the facilities. The scores generated by the peer assessment will be the basis for nomination for the annual Awards.
Nomination of the Facilities: The District Award Nomination committee would collate and analyse the peer assessment score of all health care facilities. The District committee will recommend the names of all facilities scoring 70% or more to the State level Awards Committee.
External Assessment: The districts will rank the CHCs & SDHs according to the scores and submit to state Award Committee. For formal recognition and award, an external assessment would be carried out in the nominated facilities by teams of external assessors to validate the scores generated through the peer assessment mechanism. For selecting the award winning DHs, CHCs & SDHs, it is essential to have state nominated teams for external assessment.
The state may decide whether external assessment in addition to Peer assessment, of such CHCs & SDHs by state nominated teams is necessary for those that have been short listed for Certificate of Commendation. In the case of PHCs, the state could delegate to the district committee the functions of constituting independent assessment teams, carrying out the assessment and finalize the award winning PHC from amongst the top three ranked PHCs. For PHCs scoring 70% and above but not considered for the award, scores generated through peer review assessment could be considered valid for making decision on Certificate of Commendation, provided the scores of the other shortlisted facilities are validated at least for eligibility. In the event that the scores are not validated for the shortlisted PHCs, no other PHC in the district with lower scores would receive a Certificate of Commendation.
Instructions to fill the Score Card - Marks : 0 for Non Compliance,
1 for Partial Compliance, and 2 for Full Compliance in every space. Do not tick or check-in the space.
STATUS UPDATE OF ACTIVITIES IN KARNATAKA
1. One day State Level Awareness Training for District Level Officials, State Level Officials and Development Partners like WHO, UNICEF, KHPT etc. has been carried out on ......
2. State Level Award Nomination Committee has been constituted under the Chairmanship of Principal Secretary.
3. First Round of Budgetary Gap Assessment was done by the District Hospitals and requirements in form of supplementary PIP was submitted to GOI
4. The program for the year has received a budget approval of Rs. 1.46 Crore(including the award cash).
5. All the 20 Districts have completed District Level Awareness Workshop at respective Districts.
6. District Level Award Nomination Committee have been constituted at respective Districts under the Chairmanship of District Commissioner.
7. All the 20 Districts have Constituted Hospital Cleanliness And Infection Control Committee at their respective District Hospitals.
8. IEC Activities for the Kayakalp Program are under Progress.
9. Second round of Re-assessment of the Hospitals after Gap fulfillment has been completed.
10. Four External Assessment Teams have been constituted for 2015-16 award- each team comprising of three members (State Level Official, Expert Working with Development Partner, Person trained as External assessor by NHSRC, on National Quality Assurance Guidelines).
11. Orientation Training of the External Assessors on Kayakalp Program and Assessment Protocol has been carried out.
12. Total Nine Hospital will be assessed by the External Assessors and results were forwarded to the State Level Award Committee for the award.
13. Winning District Hospital received the award directly from the center, New Delhi.
RESULTS OF 2015-16 AWARD