Pakistan: Service Delivery
Facility Makeovers
What Is a Facility Makeover?
Facility makeovers involve renovating, remodeling and improving the facility itself as well as refurbishing equipment. It is not considered a capital investment. A makeover is a way to improve the appearance of a health care facility – with very little resources – to provide improved quality family planning services to the urban poor.
Health care facilities in Pakistan range from primary to tertiary care hospitals. Every health facility has some standard protocols set by the Pakistan Medical Council. Generally, a clinical upgrade is subjected to budget, clientele, facility assessment and priority. However, the local government, the communities the facility serves and TCI have developed a collaborative effort referred to as the 72-hour makeover. Makeovers are a cost-effective way to promote family planning and foster community ownership of the health facility and has been implemented in Nigeria, Uganda and Senegal.
Facility makeovers are considered gender intentional because selected facilities are assessed for gender intentionality. Separate waiting areas and counseling rooms for males and couple counseling rooms are included in the final design of the facilities (where applicable). Facilities are assessed for gender intentionality through this checklist.
What are the benefits?
- Renovating existing facilities in disrepair or poorly equipped encourages clients to seek family planning services as well as other health services at those facilities.
- Ensuring the availability of basic equipment and supplies and creating a friendly, clean environment enables providers to work more effectively and take pride in their workplace.
- 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.
- Facility makeovers can also enable an increase in clientele and service uptake, leading to more revenue generation and savings.
How to implement
Week 1: Engage Stakeholders & Select Sites
Stakeholder engagement
Map out the key stakeholders in your geography. Identify the decision-makers that need to buy in to the concept. Convene joint meetings with all relevant government officials, including the Ministry of Health and local government to:
- Introduce them to the activity and the processes entailed
- Discuss the proposed timelines and start planning for the commissioning of the facility
- Identify staff needed to facilitate the process
- Introduce the assessment process planned to assess the facilities seeking a makeover and agree with the stakeholders on the mode for disseminating the assessment findings via applicable communication channels
Site selection
Identify high-volume sites and agree with government stakeholders on how facilities among the high-volume sites will be selected for makeovers. Facilities can be prioritized based on existing and potential client volume and poor infrastructure, especially in terms of lack of privacy for family planning clients, which can affect client volume and result in poor uptake of family planning services. Once sites are selected, meet with Medical Directors, family planning providers, and providers at integration points (e.g., labor ward, antenatal clinic, postnatal clinic, post-abortion care units, immunization units, and HIV units) of the selected sites at the facility and introduce them to the activity and what all is required.
Week 2: Conduct Assessment & Identify Local Artisans and Vendors
Conduct assessment
Initiate your baseline through a prerequisite set of forms or protocols. Ensure that all the government stakeholders are involved and informed about various stages of your baseline. During this process:
- Plan to conduct the assessment in the first week. Visit health facilities and conduct the assessment 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 Greenstar’s baseline evaluation forms to record and share the findings.
- Prepare a brief one-pager on the key highlights per facility to communicate to policymakers.
Identify and recruit artisans and vendors
Concurrently, engage with local stakeholders, such as the to generate a pool from the catchment area of each high-volume site.
Week 3: Develop an Admin Committee, Orient Artisans, Develop SOW & Budget, and Engage the Community
Admin team
Develop a committee that will supervise the makeover, coordinate with artisans, and evaluate the progress of the scope of work (SOW), which is further detailed below.
Orient artisans
Orient artisans on the types of family planning services offered at the facility, the planned renovations as determined by the baseline assessment, and the expected quality of work by sharing photos from previous makeovers conducted at other facilities.
Develop an SOW and budget for the makeover
Based on the findings from the baseline assessment, prepare an action plan and timeline for each facility makeover (i.e., batching the facilities for a makeover). This is where the pool of artisans generated in week 2 is engaged with the admin team by the assessors to agree on the actual work to be carried out in each facility. Work with the artisans to get quotations based on the SOW determined for the makeover. The quotations received are used as a guide in developing the budget. 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 4: 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 5: Implement and Reveal the Makeover
Implement facility makeover
Ensure that the service providers have approved the plan and there is a backup plan for delivering services while the renovations are taking place.
Reveal makeover in a public event
Hold public commissioning when the makeover is complete with revealing 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.
What is the evidence?
Greenstar Social Marketing, under its Large Anonymous Donors (LAD) program on postabortion care, revamped 79 clinics across Pakistan. Every clinic was evaluated on a checklist and existing potential. The selected clinics were remodeled and renovated per existing standards with the latest equipment, autoclaves, infection control protocols, and furniture.
Indicators for success
- Number of clinics renovated
- Increase in number of clients accessing family planning services
- Increase in number of clients seeking services at the renovated facility in general
Resources needed
- Vendors and artisans
- Checklists to ensure schedule
- Well-equipped admin support
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Tips
- Some facilities will need more work than others; make separate action plans for each facility.
- If resources are limited, consider doing a basic makeover that includes cleaning and repairs to make existing equipment functional.
- Involve the community in the makeover to encourage a sense of ownership of the facility.
- Batch facilities for makeovers by proximity to ease the burden on those involved in the process as well as allow the opportunity for multiple sites to be commissioned (reopened) on the same day.
- Prepare all supplies and equipment before the makeover begins so you can complete it within the allotted timeframe.
- After the makeover, commit to refreshing the facility on an ongoing basis so the tasks are more manageable.
Challenges
- A major facility makeover requires considerable effort. To prevent the need for another major makeover soon, continually monitor the facility to ensure equipment and supplies are functioning and available.
- Facility makeovers are only one component of ensuring quality family planning services. You will also need to train providers and ensure strong logistics systems.
