Dashboard Nigeria: Service Delivery 72-Hour Clinic Makeover

Nigeria Toolkit: Services & Supply

72-Hour Clinic Makeover

What is it?

To make family planning services more inviting for clients and address the dilapidated infrastructure and state of disrepair of the facilities that the PIA revealed, TCI helps States to improve quality FP services without disrupting normal daily services by implementing the cost-effective 72-Hour Clinic Makeover approach. Cost-effectiveness is ensured through direct labor, which brings about community involvement.

The 72-Hour Clinic Makeover approach is not a capital investment; it’s a top-up, improving the physical environment of clinics or other facilities that provide family planning services based on priorities identified as part of a makeover assessment. During the makeover, facilities are renovated, refurbished and equipped for optimal family planning service provision. By engaging the community and local artisans and vendors throughout the makeover process, the facility makeover also becomes a mental makeover restoring the community’s confidence in the facility and its services.

The 72-Hour Clinic Makeover is the culminating event after providers have been trained or retrained and provided materials for referrals, job aids, SOPs, IEC, etc. and communities have been mobilized.

Why is it important?

Renovating facilities that are in disrepair or poorly equipped encourages clients to seek family planning (FP) services at the facilities
Ensuring basic equipment and supplies and creating a friendly, clean environment enables providers to work properly
Seeing a dramatic change in a short time creates excitement among the community and inspires clients to seek services. In addition, due to the community involvement throughout the process, the facility makeover enshrines a sense of community pride and ownership

What are the steps for implementing this approach?

Week 1: Engage Stakeholders & Community Members

Stakeholder Engagement

In preparation for the 72-Hour Clinic Makeover, planning meetings are held with the State/LGA/Health Facility(ies) officials. It is also important that the State and/or LGA Health Educator/Social Mobilization Officer (SMO) who are part of the SBCC Committee participate in the planning meetings. The LGA Health Educator/SMO is responsible to provide details about the social mobilization component of the Makeover as well its implications for the SBCC Committee.

The assessment, planning and implementation of the 72-Hour Clinic Makeover is carried out with the State health regulatory agencies, management of the facility and Ward Development Committee (WDC) to ensure community involvement and commitment in the “makeover process”.

Community Engagement and Identify Artisans & Vendors

Concurrently, engage with the community to see how they can assist during and prior to the makeover weekend. For example, community members may volunteer to supervise the artisans during implementation or mobilize people to clean the facility environment.

In addition, community members, particularly through the QIT team, are met to generate a pool of artisan and vendors from the catchment area of the makeover site.

Week 2: Conduct Makeover Assessment, Secure Renovation Work Quotations and Develop SOW & Budget

Conduct MO Assessment

Although sites were selected during the PIA process, a second-level makeover (MO) assessment is conducted to identify the scope of work for the artisans and confirm equipment functionality status as earlier identified on the PIA tool. As a result, the artisans are invited to the facility during the MO assessment to jointly work with the government and TCI team to determine SOW for different work areas needed.

Whenever possible, use existing meetings with the Health Management Team and the Quality Improvement Team (QIT), if it is already established, as well as Health Management Information System (HMIS) and Reproductive Health/Family Planning (RH/FP) officers to debrief them on and engage them in the assessment process to avoid incorrect assumptions about the state of the family planning facility.

The MO assessment is conducted in a day to identify items needing repair and supplies needing replacement. With health facility staff, prepare a prioritized list of renovations, repairs and improvements for each facility. Where possible, use Open Data Kit (ODK) – an open source software – to record and share the findings.

Renovation work quotations

The renovation work quotations are submitted by the artisans following determination of the scope of work. These quotations cover all areas requiring makeover in the health facility.

Develop scope of work (SOW) and budget with artisans

Based on the findings from the MO assessment, prepare an action plan and timeline for each facility makeover (i.e., batching the facilities for makeover). Work with the artisans to get quotations based on the SOW determined from the MO assessment findings. The quotations received are used as a guide in developing the budget. In addition to the renovation costs, make sure to budget social mobilization activities and secure approval for the makeover budget; see the Guide to Social Mobilization for 72-Hour Clinic Makeover for more details.

A detailed checklist can facilitate coordination of the process, organization of tasks including the commissioning or opening event and assembly of all materials required.

Week 3: Procure Equipment & Furniture

Equipment and furniture purchase and transport

Communicate in advance when you expect the vendors to deliver the equipment and furniture needed for the makeover. Determine where, when and to whom the deliveries should be made. Branding arrangements should be made at this point as well.

Week 4: Implement, Mobilize the Community & Reveal the Makeover

Implement Facility Makeover

To avoid interrupting weekday services, repairs and renovations are carried out throughout the weekend, beginning at the clinic’s close of business on a Friday. By Monday morning, the clinic reopens in a renewed state, ready to provide optimal family planning services.

Mobilize the Community

A key component of the 72-Hour Makeover is Social Mobilization. The Social Mobilization during 72-Hour Clinic Makeover is aimed at creating awareness about the Makeover in communities around the designated health facilities, conducting sensitizations as well as referrals to the facilities where the Makeover is taking place. The social mobilization is conducted through a combination of the following activities:

Neighborhood Campaigns which are carried out from door-to-door
Sensitization exercises at Association meetings within the community
Other community gatherings/events taking place around that period

Note: It is important to clarify the following information before heading into the community to start mobilization. This is to ensure that prospective clients have the information they need to receive a stress-free service.

Clinic opening hours
Any payment(s) to be made by prospective clients, the specific amount and reasons for the payment
Adequacy of staff in the FP clinic to cope with the expected rise in client flow particularly on the day of the commissioning

Reveal Makeover in Public Event

Hold a public commissioning when the makeover is complete to reveal the improvements; invite a prominent leader to officially reopen the facility. Use the opportunity to promote the services offered at the facility and encourage community leaders to show their support for family planning.

Results and Lessons Learned

In line with TCI’s Business Unusual model of providing support to States to lead and implement high impact reproductive health interventions, the 72-Hour Clinic Makeover is spearheaded by the States with technical input and guidance from TCI. TCI’s three-pronged approach to program implementation – Advocacy, Demand Generation and Service Delivery – are all employed in executing the 72-Hour Clinic Makeover.

TCI employs but has adapted NURHI’s nine-step approach in order to allow State teams to spearhead the implementation of the 72-Hour Clinic Makeover. Learnings from TCI’s experience has led to the refinement of this process in which multiple steps can be carried out within each week. Following this process, 31 facilities have benefitted from the 72-Hour Clinic Makeover to date; there are plans to scale up this proven approach and process to 50 facilities in 10 states across Nigeria.

To learn more about our lessons learned, click on the image at the left.