Oromia-Health-Facility-Improvement up dated.docx

Oromia-Health-Facility-Improvement up dated.docxOromia-Health-Facility-Improvement up dated.docx

1. Oromia Health Facility
Standards Improvement
Manual
Elevating Care Through Design and

2. Infrastructure Adamaoct
/2025

3. Contents
•General Overview of Health Facility Improvement
Standards.
•Technical Standards and Design Specifications.
•Implementation Strategy and Governance.
•Roles and Responsibilities of Stakeholders.
•Standardized Weighted Evaluation Checklist.

4. Overvie
w
•The Vision vs. Reality: Ethiopia's national policy promises safe, high-quality healthcare for all,
but a significant gap exists in Oromia.
•Inconsistent Standards: A lack of uniformity in facility design, operation, and patient experience
creates an unreliable standard of care.
•A Threat to Patient Safety: Inconsistent safety protocols, particularly in Infection Prevention and
Control
(IPC), lead to preventable Healthcare-Associated Infections (HAIs), with rates as high as 9.7% in our
region.

5. •Eroding Public Trust: Facilities often fail to project an image of safety and competence,
damaging community confidence in the public health system.

6. The Solution: A Unified
Implementation
Manual
•A Mandate for Change: The Oromia Health Bureau has
developed a comprehensive Implementation Manual to establish
a single, high standard of excellence for all government health
facilities.
•Holistic Approach: The manual moves beyond standardize
every aspect of the facility environment, from safety protocols
to patient experience.
•Core Principle: To ensure quality, safety, and dignity are
guaranteed by design, not determined by location.

7. Purpos
e
•Establish a Unified Standard of Excellence: Eliminate inconsistencies and guarantee the same high standard of care
for
every citizen.
•Provide Actionable Guidance: Equip all staff with practical, step-by-step instructions for implementation.
•Embed a Culture of Safety: Make patient and staff safety the foundational principle of our physical environment.
•Build Community Trust: Create visibly clean, professional, and welcoming facilities that earn public confidence.
•Empower Local Leadership and Foster Ownership : sustain a culture of proactive maintenance and continuous
quality enhancement.

8. •Ultimately, the purpose of this manual is to make health facilities Clean, Green and Comfortable for health
workforce, patients, visitors and local communities.

9. Rationale
❑The Patient Safety Imperative: Combating Preventable Harm
▪The most critical rationale for this manual is the moral and clinical imperative to
protect patients and health workforce from preventable harm.
▪High rates of Healthcare-Associated Infections (HAIs) are a direct consequence of
unstandardized practices in environmental hygiene, sanitation, and waste
management.
▪This manual provides a single, non-negotiable standard of safety, transforming our
facilities from potential sources of infection into true sanctuaries of healing.

10. Rationale
❑Rebuilding Public Trust and Confidence
•Public trust is the currency of a successful health system. Currently, the vast inconsistency in
the appearance and functionality of our facilities sends a mixed message to the community.
•By standardizing the physical environment—from professional gates and clear signage to
clean waiting areas, therapeutic color schemes, and calming Healing Gardens—we make a
visible promise of quality, dignity, and respect.
•This consistency is essential for building an unwavering sense of confidence and
encouraging our
communities to seek care without hesitation.

11. Rationale
❑ Driving Efficiency and Sustainability
▪Investments in infrastructure and equipment cannot be strategic or
sustainable without a common blueprint for maintenance and operation.
▪Byestablishingstandardsforworkshopsandpromotingacultureof
proactive
maintenance, we shift from a costly, reactive "break-fix" cycle to a sustainable
model
of asset management.

12. Rationale
❑Empowering Staff and Clarifying Accountability
▪Effective action requires clear direction.
▪Facility leaders, managers, and staff cannot be held accountable for achieving a
high standard if that standard is not clearly defined.
▪This manual serves as a single source of truth, providing a common language
and a shared set of expectations for everyone in the system

13. Objective
s
General Objective: To create standardized, high-quality, attractive, and safe
health facilities where the safety of patients, clients, and employees is
guaranteed.
Specific Objectives:
•Standardize design for all key areas (entrances, signage, Reception Areas
and Patient Waiting Areas)
•Guarantee the health and safety of everyone on-site.
•Implement a standardized, branded color scheme across all facilities.

14. •Create clean, attractive, and welcoming environments

15. Scope
•This Implementation Manual establishes the official, mandatory
standards for all government health facilities within the administrative
boundaries of the Oromia region.
•Its authority extends across all levels of the public health system,
from Health Posts and Health Centers to General and Specialized
Hospitals, applying to both urban and rural settings.

16. In-Scope Components
Facility Infrastructure and Design :
The standardized design, and renovation of all key facility areas, including:
oEntrances (Gates) and Perimeters (Fences and Live Fences)
oReception Areas and Patient Waiting Areas
oInternal (Corridor) and External Walkways
oDedicated Ambulance Entrances and Emergency Bays

17. In-Scope Components
❑ Regional Standardization and Branding:
oExterior and interior wall paints
oColor schemes for specific service areas (Gates, Fences, Emergency Rooms,
Wards, Pediatric Wards, corridors, waiting areas, receptions etc.)
oStandardized, multilingual Signage

18. In-Scope Components
❑Therapeutic Environment: The mandatory creation and
maintenance of environments that promote healing, including:
oThe integration of Greenery throughout facility compounds.
oThe establishment of designated Healing Gardens for patients and
staff.

19. In-Scope Components
❑Maintenance and Sustainability: Establishment of fully equipped
workshops
to foster a culture of proactive maintenance, with defined capabilities for
metal work, wood work, electrical and electronics repair, cloth sewing, and
painting.
❑Inclusive and Accessible Design:Full accessibility for persons with

20. disabilities.

21. In-Scope Components
❑Support Services: The standards for providing clean, safe, and
accessible Cafeterias and Shops for patients, caregivers, and
staff.
❑Foundational Safety and Hygiene: The implementation
of standardized protocols for Water, Sanitation, and
Hygiene

22. (WASH) and Infection Prevention and Control (IPC).

23. Expected
Outcomes
•Branding and Trust: Facilities will be easily recognizable and trusted by
the community.
•Improved Patient Flow: Well-designed spaces will lead to more efficient,
high-
quality care.
•Improved Safety: Standardized waste management will reduce infections
and ensure patient/staff safety.
•Increased Service Uptake: Greater community confidence will drive
demand
for public health services.

24. •Culture of Maintenance: On-site workshops will ensure the longevity
and quality of our infrastructure.

25. Technical Standards and Design
Specifications of Health
Color Scheme selected for branding of health institutions in Oromia
Color Name RAL Code Color
Light Blue RAL 5012
Pure White RAL 9010
Light Green RAL 6027
Light Grey RAL 7035
Dark Gray (for text) RAL 7016
Blue Black RAL5004
Brown RAL 8003
White RAL 9010

26. Approved Color Palette
•The selection of colors for our health facilities is a
strategic,promote healing and psychological well-
being by reducing patient stress, anxiety, and agitation.
•Itdesigned to create a psychologically calming and
professional
environment.
•Simultaneously, bright and natural colors are employed to
enhance the perception of cleanliness, creating an
environment that feels hygienic and safe.

27. The First Impression: Entrance and Exit
Gates
professional two-tone scheme:
oPrimary Color: Light Gray (RAL 7035)
oAccent Color: Pure White (RAL 9010)
oThis combination creates a clean, modern,
orecognizable brand identity

28. esign

Mandatory Standards
❑Facility Identification and Signage
✓A dedicated overhead signage element, formwork d
oColor: Dark Gray (RAL 7016) .
oFont: Arial,.
oLanguage Order:
o1.Afaan Oromo (Top line or most prominent position)
o2.Amharic (At middle position)3.English (At the bottom)

29. The First Impression: Gates &
Fences
Fences: Security & Green Integration
oMain Body: The primary, larger surfaces of
the fence (panels, walls, main posts) must be
painted in Light Gray (RAL 7035).
oDecorative Accents: Smaller elements, such
as post caps, ornamental features, must be
painted in Pure White (RAL 9010) to provide

30. a clean, professional contrast.

31. The First Impression: Gates &
Fences
Fences: Security & Green
Integration
•Side & Rear: A "Life Fence" of
dense hedges and plants is
the primary standard,
integrated with security

32. fencing where needed.

33. Roads & Walkways
❑Internal Roads: Material by Facility
Level
•Hospitals : Asphalt,
• Health Centers : Interlocking Pavers.
• Health Posts : Compacted Red Ash
❑Non-Negotiable Accessibility
•Universal Design: All paths must be fully accessible for
persons with disabilities.
•Ramps: Mandatory at all changes in elevation. 5-degree
slope or 1:12 ratio.

34. Covered Walkways
Covered Walkways: Must have a
roof and a durable, Light Gray
Terrazzo floor.

35. The Indoor Environment: Floors &
Patient Areas
Interior Floors: Hygiene is Paramount
•Standard: Must be non-
porous, durable, non-slip, and
seamless.
Approved Materials:
•Ceramic Tiles: For high-traffic
corridors, patient rooms, and
waiting areas.
•Epoxy Flooring: For Operating
Theatres, labs, and sterile areas.

36. Reception and Waiting area
Reception & Waiting Areas:
Welcome & Comfort
•Reception: A single,
professional, and clearly marked
main desk.
•Waiting Areas: Spacious,
comfortable seating, abundant
natural light, and walls painted
in calming light Green(RAL 6027)
and Pure White(RAL 9010).

37. Critical Access
Emergency Entrance: Speed & Safety
•Dedicated Access: Unobstructed 24/7
access for ambulances.
•Full Accessibility: Must have an
integrated, permanent ramp.
•Signage: High-visibility RED
background with WHITE text for
universal recognition.

38. Restorative Spaces
•Amenities: Cafeterias & Healing
Gardens
•Cafeterias/Shops: Must be clean,
accessible, and adhere to strict
hygiene standards.
•Food mustbeprovide according to the
menu item provided by regional health
bureau.

39. Restorative Spaces
•Healing Gardens: Mandatory
for all facilities.
•A designated, peaceful,
green space with seating
and shade for the mental
well-being of patients and
staff.

40. Branding Our Buildings: Standard
Wall Colors
Facility Exterior Color Scheme Interior Color Scheme
Hospitals Pure White
Lower Walls: light Green
Upper Walls: Pure White
Health Centers
Walls: Pure White
Light BluewithPure White
Health Posts
Walls: Pure White
Light GraywithPure White

41. Interior Corridors & High-Traffic Areas(hospital)
Two-tone application:
•Lower Portion (from floor to
dado rail height, approx. 1.2
meters): Light Green (RAL 6027)
•Upper Portion (from dado rail to
ceiling): Pure White (RAL 9010)

42. Patient Wards & Rooms(hospital)
Primary Walls: light
Green
(RAL 6027)
accented with Pure
White (RAL 9010)

43. Clear Communication: Signage &
Notice Boards
Directional Signage: Guiding with Clarity
•Color Scheme: Blue-Black background
with White text for high contrast.
•Language Order: Mandatory
trilingual format:
1.Afaan Oromo
2.Amharic
3.English
.

44. Clear Communication: Signage &
Notice Boards
•Visibility: Must be well-lit
and placed at all key
decision points.
•All information must be
posted on designated notice
boards with a Gray frame
and Blue Black background.

45. The Facility Workshop
❑Mandate: All Hospitals and Health Centers must
establish a dedicated workshop.
❑Purpose: To shift from a reactive "break-fix" model to a
proactive culture of maintenance.
❑Core Functions: The workshop must be equipped for in-
house repairs including:
❑Metalwork & Welding (beds, trolleys),Woodwork (furniture,
doors),Electrical & Plumbing, Sewing (linens,
uniforms),Painting

46. Waste Management
A secure, fenced "Waste Zone" is mandatory for final
1. Segregation at Source: The most critical step. Use correct color-coded
every point of
o Black: General
o Yellow: Infectious
o Red: Highly Infectious
o Sharps Box: For all
2.Safe Transport: Use dedicated, covered carts. Bags must be sealed
when ¾ full.
3.Final Disposal: Use a high-temperature Incinerator for infectious waste
and a Placental Pit for anatomical waste.

47. Incinerator design
NOTE- LEAVE 5-10CM GAP
BETWEEN IRON BARS
GROUND
SECTION Y-Y
INCINERATORTYPE 2
190
200 200
VIEW AT 1m FROM
GROUND
VIEW AT 4m FROM TOP VIEW
FRONT ELEVATION
SIDE ELEVATION
SIDE ELEVATION
SIDE ELEVATION
REAR
LEFT
RIGHT
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48. Hygiene & Sanitation
Hand Hygiene:
•Access: A functional handwashing
station (water + soap) must be within
5 meters of every patient bed and at
all key points. Alcohol-based hand rub
must be widely available.
•Practice: All clinical staff must adhere
to the WHO 5 Moments for Hand
Hygiene.

49. Hygiene & Sanitation
Latrines: Dignity & Safety
•Segregation: Separate, clearly marked
latrines for Males, Females, and Staff.
•Accessibility: At least one accessible cubicle
for persons with disabilities in each block.
•Standard: Must be clean, well-lit,
ventilated, and have a lockable door for
privacy.

50. Implementation Strategy and
Governance
•Phase 1: Planning and Mobilization
This initial phase is focused on translating this manual into
concrete, context-specific action plans and building the
necessary coalition for success.
❑baseline assessments
❑Based on this assessment, the FIC will develop a nine
month, costed Action Plan

51. ❑Advocacy

52. Phase 1: Planning and
Mobilization
❑ Stakeholder Coordination and Alliance Building:
Present the facility’s Action Plan to stakeholders to secure their formal buy-in
and
support. Key partners include:
•Local Government: Woreda/District Administration, Mayor's Office ,zone
•Essential Utilities: Water and Power Authorities.
•Community Leadership: Kebele leaders, elders, and religious leaders.
•Conduct a high-profile Community Mobilization Launch Event at the
facility to raise broad public awareness

53. Phase 2: Resource Mobilization and
Execution
•This phase focuses on securing the necessary financial and in-kind
resources and beginning the implementation of planned projects.
1.Diversified Funding Strategy:
oInternal Revenue
oCommunity and Business Partnerships(financial and in-kind
contributions)
oNGO and Development Partners
oPublic Fundraising Events(health bazaars, telethons, or fundraising
dinners to generate broad-based community donations)

54. Phase 2: Resource Mobilization and
Execution
2."Adopt-a-Zone" Initiative
•Divide the facility compound into distinct zones (e.g., "Main
Entrance & Garden," "Maternity Wing Exterior," "Waste
Management Zone").
•Partner with local businesses or community groups to "adopt"
a zone, taking responsibility for financing and developing it
according to the standards in this manual.

55. Phase 3: Monitoring, Evaluation,
and Continuous
Improvement
•This phase ensures accountability, provides crucial support,
and
creates a cycle of learning and improvement.
1.Structured Reporting Cascade: from health post to the
region
2.Performance Reviews and Supportive Supervision:
•Quarterly Reviews: Woreda, Zonal, and regional levels

56. •Supportive Supervision Visits: Regional and Zonal
technical committees

57. Phase 3: Monitoring, Evaluation, and
Continuous Improvement
3.Sharing and Scaling Best Practices
▪All levels of the health system are responsible for documenting
and
sharing success stories and innovative solutions.
▪The Oromia Health Bureau will systematically identify the
most effective models and best practices scaling up across
the entire region through workshops, learning visits, and
official communications.
4.Recognition and Motivation byRegion, Zonal/Town/District

58. Phase 3: Monitoring, Evaluation, and
Continuous Improvement
3.Health Facility Status Classification
This system ranks facilities based on the successful implementation of key
improvement milestones.
•Pre-Model Facility (1
st
phase of implementation)
Achieved by completing foundational infrastructure and aesthetic
upgrades.
Key Projects: Standardized gates, ambulance entrance, facility
painting, improved reception and waiting areas ,clear signage, and
Fenced waste disposal sites.

59. Phase 3: Monitoring, Evaluation,
and Continuous
Improvement
•Model Facility (2
nd
phase of implementation)
Awarded to facilities that meet all "Pre-Model" criteria
and enhance the environment for patients and staff.
Key Additions:Internal roads, walkways, green
spaces, healing gardens, a café for staff and patients, and

60. a general workshop.

61. Phase 3: Monitoring, Evaluation, and
Continuous Improvement
•Best Facility (3
rd
phase of implementation)
The highest tier for facilities that have met all "Model" criteria and
invested
in specialized, high-quality amenities.
Key Enhancements: A children's playground, a dedicated
workshop for medical equipment, and an upgraded "model" café .
•Note the 1
st
and 2
nd
phase of implementation phase should be
completed in the 1first and 2
nd
Quarter of a years 2018 and 3
rd
phase will
at 3
rd
Quarter of the years.

62. Roles and Responsibilities of
Stakeholders
Chapter Four role and resposibilites.docx

63. Standardized Weighted
Evaluation Checklist
•Chapter Five chceklist.docx

64. Horaa Bulaa !!