MC MOVE Models for optimizing the volume and efficiency of MC services By Dr Dino Rech.
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Transcript of MC MOVE Models for optimizing the volume and efficiency of MC services By Dr Dino Rech.
![Page 1: MC MOVE Models for optimizing the volume and efficiency of MC services By Dr Dino Rech.](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b097f8b9ab05998961b/html5/thumbnails/1.jpg)
MC MOVEModels for optimizing the volume and efficiency of MC
services
By Dr Dino Rech
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MC MOVE• Evolution of efficiency principles in surgery and
MC• Efficiency principles used in MC• Progress to date
– New sites and programs– Research– Ongoing evolution.
• Efficiency challenges– Balancing demand and supply/ seasonality– Counselling and communications– Part time MC providers vs specialised teams
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Evolution of efficiency principles in surgery and MC…e.g.
Aravind Eye Hospital India
Orange Farm South Africa
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Evolution of efficiency principles in surgery and MC
MOVEWHO pilot initiative:
Aims to maximise Surgical results and minimising time and resources needed to perform high
volumes of surgery.
Facilitates cost effective solutions to MC scale up in high volume/demand settings
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Task-Shifting
- Training / certification of entire MC procedure to lower health cadres, e.g., clinical officers, nurses.
Efficiency Principles used in MC
Task-Sharing
Assign steps to lower cadres:- Surgical area clean & prep- Anaesthetic block- Final foreskin stitches- Wound dressing
Sharing supported by:- 4 beds per operator- 6 lower cadres per operator- Theatre layout for staff flow- Alcohol gel hand sanitizing- Gown change only if blood
Surgical Efficiency Techniques
Task-Shifting Task-Sharing
Techniques
- Forceps-guided- Cautery (monopolar) for haemostasis - Fewer stitches (8-12) for foreskin apposition- Collective wrap of surgical items- Pre-assembled surgical kits- Theatre layout for faster patient turnover
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The Fourth Efficiency Principle
Adequate Client flow and demand for services
-Communications
-Mobilization
-Counselling and testing services
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Surgical layout
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Efficiency focused MC Kits
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Surgical Methods
Surgical methods compared
Time savings to surgeon/procedure
Forceps-guided/dorsal slit 2:25
Forceps-guided/sleeve resection 7:40
Dorsal slit/sleeve resection 5:15
* Times depicted are based on time-motion observations at Orange Farm, South Africa
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Results
Indicator Pre‐MOVEMOVE
(Sleeve)
MOVE (Forceps Guided)
Doctor Operating Time
25‐50 min. 10‐20 min 5‐10 min
Cubicle Turnover Time
60 min 30‐40 min 25‐30 min
# of Clients 1‐2 an hour 3‐5 an hour 5‐8 an hour
* Note Graph with initial impact and results from Tanzania.
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Progress to date
• Efficiency focused( use of MOVE) implementation – South Africa – Swaziland– Zimbabwe– Tanzania– Botswana– Zambia– Kenya
• Research Efficiency or MOVE Evaluation
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Aggregate Numbers – Four Pilot Sites. Tanzania
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MOVE Begins
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Challenges to implementing efficient high volume services
– Balancing demand and supply / managing seasonality of demand
– Counselling and communications: How to keep up?
– Part time MC providers VS specialised teams: Pros and Cons
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New Super Efficient MC Device in SA???