People Centered Healthcare for Tsirang and Punakha_FINAL.pptx

Transforming NCD Care by Keeping People at the Heart of Care: PEN HEARTS Initiatives in Tsirang and Punakha.

1. Transforming NCD care by keeping people at the heart of care: PEN HEARTS initiatives in Tsirang and Punakha Dr. Tshewang Gyeltshen, BDS General Duty Dental Surgeon Tsirang Hospital Our Stories 18 th September, 2019

2. What is People-Centered Healthcare Service?

3. Salient features of PEN versus PEN HEARTS Former PEN programme Inactive recall and reminder Inactive refill of second medicines Inactive referrals No mentoring No outreach Doctors disengaged from BHUs Inadequate team operation People- centred PEN HEARTS initiatives Recall and reminder Refill by BHU staff Referral communication Reach-out (community care) BHU clinical mentoring Doctors fully engaged Team-based concept

4. CONTINUOUS COORDINATED COMPREHENSIVE People- centred PEN HEARTS = 3 Cs + 7Rs

5. Treating the whole person Lifestyle interventions and brief interventions – alcohol, tobacco, unhealthy diet, physical inactivity BP and BMI measurement Recall and follow up Coordinated referrals Home-based outreach

6. Tshochagsa BHU visits on 28 th day of every month for follow up and refill of medicines. Also coordinates blood sample collection by Punakha hospital - Thinley Norbu, HA

7. Medicine refilled at BHU II (using Form III) NCD drugs are routinely supplied to the BHU levels are transferred using Form III for patients.

8. Tsirang People availing Form II drugs Punakha People availing Form II drugs Barshong 32 Goenshari 8 Dunglagang 62 Kabesa 14 Phuntenchu 23 Nobgang 29 Semjong 41 Samdingkha 48 Tsirangtoe 40 Shengana 19 Mendregang 39 Thinleygang 68 Sergithang 19 Tsochagsa 35 Patchaling Subpost 15 Lobesa Subpost 22  TOTAL 271   243 People using form III refill 514 person days of averted hospital visits per month

9. Strong leadership, smart management Backbone of delivering high quality people- centred care n eeds creation and nurturing of collective engagement, commonly held values, good communication, teamwork and transparency.

10. PEN peer coaching: learning together Kabesa BHU visit in Punakha PEN peer coaching in MCH in Tsirang Hospital

11. Wechat PEN HEARTS group: real time problem solving

12. Culture of clinical mentoring and supportive supervision: DHOs and CMOs as teams

13. Faces behind the numbers : home visits* Case burden Punakha Tsirang Total   Cases Visits Cases Visits Cases Visits Stroke 14 9 17 25 31 34 Cancer 3 1 2 4 5 5 Paraplegia 8 8 7 20 15 28 Other homebound 43 10 6 53 6           104 73 * June to 15 September 2019 Less than one home visit per patient in three months

14. Common NCDs under treatment Common NCDs Punakha Tsirang Total Hypertension 992 1030 2022 Diabetes  259  202  461 COPD  11  61  72 Asthma  15  59  74 2629

15. Summary: How patients benefit with this initiative Reduce chances of treatment interruption for hypertension and diabetes due to reminder/recall Minimize travel time and cost to hospital – care nearer to communities Home-bound patients/families receive some level of home visit- reaching the unreached

16. Summary: How health systems and staff benefit Health workers’ confidence and feeling of sense of purpose Patient confidence in health facility Team spirit among staff Improvement in district health service management People- centred model can be used for all health service delivery (communicable diseases, RH/MCH, and mental health)

17. Submission People Centered HEARTS- potential model of chronic care for Bhutan- consider to roll out as a national programme Standardize the level of care of People Centered HEARTS Initiative in whole of the Bhutanese healthcare System. Learn from this model and apply people –centered approach in other care services not limiting to NCDs. Health worker visits to communities and homes are essential to improve NCD care – formalize it Proper transportation arrangements will be required to support the refill of medicines to BHUs – prepare the SoP guidelines An able district health services management team is critical to lead the people-centered NCD services – review and strengthen the district health offices and hospital management

18. WITH SINCERE THANKS FROM HEALTH WORKERS OF PUNAKHA AND TSIRANG DZONGKHAGS