TCI University Toolkit: Services & Supply
What Is It?
A facility makeover 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 an 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.
What Are the Benefits?
- 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
How to Implement?
TCI Nigeria adapted the Nigerian Urban Reproductive Health Initiative’s (NURHI’s) nine-step proven 72-hour facility makeover approach, which often took 4-6 months previously to prepare for the 72-hour transformation to 4-5 weeks. Learnings from TCI Nigeria implementation has led to the refinement of this process in which multiple steps can be carried out within each week. This adapted process is being scaled up in 10 states across Nigeria.
Week 1: Engage Stakeholders & Select Sites
Map out the key stakeholders in your geography. Identify the decision makers that require buy-in. Convene joint meetings with all relevant government officials, including Ministry of Health and local government to:
- Introduce them to the activity and the processes entailed;
- Discuss the proposed timelines and start planning for commissioning of the facility, which happens the Monday post-weekend makeover;
- Identify staff needed to facilitate the process; and
- Introduce the assessment process planned for week 2 and agree with the stakeholders on the mode for disseminating the assessment findings – which can be through a presentation at an upcoming contraceptive technology update meeting or other planned meetings, print hard copies or email. The dissemination must take place at the end of week 2 or the beginning of week 3 at most.
Identify high volume sites and agree with government stakeholders on how facilities among the high volume sites will be selected for makeovers. Once sites are selected, meet with Medical Directors, family planning providers, and providers at integration points (e.g. labor ward, antenatal clinic, post-natal 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 Artisans and Vendors
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 family planning facilities and their use and highlight areas that need to be strengthened.
Plan to conduct the assessment, such as a Performance Improvement Assessment, in two days. 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 Open Data Kit (ODK) – an open source software – 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 QIT team, to generate a pool of artisan and vendors from the catchment area of each high volume site.
Week 3: Orient Artisans, Develop SOW & Budget and Engage the Community
Orient artisans on the expected quality of work by sharing with them photos from previous makeovers.
Develop scope of work (SOW) and budget for the makeovers
Based on the findings from the assessment, prepare an action plan, and timeline for each facility makeover (i.e. batching the facilities for makeover). This is where the pool of artisans generated in week 2 are engaged together with the QIT 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.
Engage with the community to see how they might be able to contribute to the weekend of the makeover or prior. This may range from supervision of artisans during implementation to mobilization of persons to clean the facility environment.
Week 4: Procure Equipment & Furniture
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 & Reveal the 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.
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.
The 72-hour makeover is a dream come true. The place I was before was like a cave. Everything was jam packed. Sometimes my clients had to wait outside. They had no seating places at all. But now, I have everything that an ideal family planning room is supposed to have.
What Is the Evidence?
- Improving family planning facilities was “critical for technical quality and infection prevention, privacy for women, cleanliness and to make the clinic a place that both providers and clients would be willing to spend time in.” (Retrospective Comparative Review, page 43)
- In Nigeria, “NURHI viewed the decrepit facilities as an indicator of the ideas and feelings … of stakeholders, policy makers, the larger community, and service providers, specifically that they lacked motivation for and did not value family planning. The solution therefore involved advocacy with local stakeholders, engagement with facility administrators, participation of facility staff in the renovation process (coined as the ‘72-Hour Clinic Makeover’), and a launch of a ‘new and improved’ family planning facility that built support for the providers in their community. It is important to note that the facility renovations generally entailed a coat of fresh paint, scrubbing, connecting a sink to the hospital’s water line, and making sure contraceptive commodities and equipment were on hand—not, in most cases, major costs or construction.” (Krenn et al., 2014)
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What are some of the challenges associated with facility makeovers?
The Nigerian Urban Reproductive Health Initiative (NURHI) ’72-Hour Clinic Makeovers’, in most cases, did not include major costs or construction but rather a coat of fresh paint, scrubbing, connecting a sink to the hospital’s water line, and making sure contraceptive commodities and equipment were on hand. They found that the facility makeovers engaged facility staff to value family planning.
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Watch a Makeover in Action
- 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 if you are doing a quick makeover, so you can complete it within the allotted time frame.
- Purchasing some items directly from the open market in the course of the makeover has proven to be more cost-effective at times.
- After the makeover, commit to refreshing the facility on an ongoing basis so the tasks are more manageable.
- A major facility makeover requires considerable effort. To prevent the need for another major makeover in the future, 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, ensure strong logistics systems, and strengthen leadership and management.