| 4. In which ways is the initiative creative and innovative?
ESRP main components and activities with the chronology of the steps taken are:
Prepare a primary list of targeted hospitals.
Audit facilities against the standards.
Elaborate the final list of selected hospitals (120 MOHP hospitals).
Draw radiation protection plan and renovation plan.
Facility upgrading according to the standards and specific needs for the new X-Ray equipment.
Execute renovation and prepare sites for equipment installation.
2-Equipment Procurement and Installation:
Define specifications for the required equipments (100 conventional x-ray equipment and six mammography equipments and no. of digital x-ray equipment).
General user training on the modes of equipment operation.
3-Maintenance and Technology Management:
Enacting and implementation of the elaborated maintenance and technology management strategy for radiology equipment.
Improvement and development of 1st line maintenance standards of radiology equipment to be suitable for general implementation in all MOHP facilities according to the results of applying the 1st line maintenance standards in the selected pilot centers.
Train personnel in regular machine (user) maintenance.
Building suitable capacities for maintenance of radiology equipment, capable of providing the required support for preserving and maximizing the benefit of radiology equipment.
Strengthen MOHP planning department and technical advisors in cost beneficial technology management for radiology equipments
4-Standard Practice Guidelines:
Field testing of the elaborated standard practice guidelines.
Improvement and development of the guidelines according to the results of field testing.
Updating the guidelines according to the new concepts, methodologies & techniques in diagnostic radiology.
Training of radiologists and radiographers on the developed guidelines.
5-Quality Improvement and Supervision Scheme:
Introduce quality improvement programs.
Train officials from MOHP in quality improvement of radiology services.
Enacting the elaborated supervision scheme.
Train supervisors at all levels of supervision (according to the supervision scheme) on monitoring and supervision skills.
6-Radiology Human Resources Management:
Define priorities for radiology human resources management strategy.
Formulate adequate strategy for management of radiology human resources.
Draw long term and short term executive plans.
Orientation and collaboration with other administrations of MOHP involved in human resources management.
Enact and implement executive plans.
Define a strategy for enforcement of policies concerning radiology services.
Draw plans for integration and collaboration with MOHP decision makers to enforce the required policies.
Form a committee for radiology policies to control and organize radiology policies enforcement at all levels of decision making in MOHP.
8-Monitoring and evaluation:
Define processes indicators for radiology departments.
Elaborate measuring tools for processes indicators.
Regular assessment and update (if needed) of the applied monitoring and evaluation system.
Applied field researches and studies:
Define the objectives of required researches and studies.
Define methodology and executive plans.
Elaborate data collection tools.
Train research teams.
Execute field researches and studies.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
ESRP has a steering committee comprising of the Egyptian partner Ministry of Health & Population [MOHP] and the Swiss partner which is the State Secretariat for Economic affairs [SECO].
I-ESRP team itself:
Following the committee ESRP has 2 managers an Egyptian executive project manager and a SECO Swiss manager.
Here the project support structure is divided into 3 parts:
A-Project operations coordinators [task force]:
1-The sites rehabilitation coordinator
2-The equipment procurement coordinator
3-The maintenance coordinator
4-HR development and training coordinator
5-Supervision and quality management coordinator
6-Monitoring and information coordinator
7-Standard and guidelines coordinator
B-Administrative support office:
3-Data entry assistant
C-Project implementation assistant office:
1-The curative sector
2-The planning department
3-The purchasing department
1-universities bodies through the different consultancy aspects
2-Local authorities at the different governorates
3-Other ministries namely the ministry of planning, ministry of international cooperation and ministry of finance
| 6. How was the strategy implemented and what resources were mobilized?
ESRP is a Mixed Financing project between Egypt [50%] and Switzerland [50%], a Memorandum of Understanding between the Government of the Swiss Confederation and the Government of the Arab Republic of Egypt was signed where the Swiss State Secretariat for Economic Affairs (SECO) assisted the MOHP in its efforts through the financing of radiology equipments and film processors. In addition, SECO financed a Technical Assistance Program [TAP] through a grant.
•MOHP took all actions, including the equipment, trained personnel, guidelines, offices and the monitoring system provision of sites, facilities, services, consumables, means of transport (in addition to the transportation van and other travel expenses already included in the TAP) and other measures, necessary for the successful implementation of the Project i.e., the upgrading of radiology services in an additional number of hospitals of the MOHP as well as the Technical Assistance Program.
•All equipment, material and services provided out of the Swiss funding, comprising the Mixed Financing and the TAP
•The MOHP provided qualified and experienced personnel for the PIU Chair and the Task Groups for the duration of the project implementation as well as A furnished office and training facilities of the ESRP.
•The rehabilitation of the sites is financed by the MOHP. These costs include, but are not limited to, devices such as electric installation, IT-cabling, which are reflected in the estimated construction/refurbishment costs for new radiology departments.
3-Equipment and Services
•The Egyptian authorities supported and facilitated efficient customs release of imported equipment financed under this Project.
•MOHP organized the local procurement of furniture and accessories required for the Project.
•SECO financed the procurement of additional radiology equipment, accessories, consumables and related services. Also provided professional project management support and specific expertise.
4- Financial Sustainability
•MOHP allocated the budget required for personnel, in-house maintenance and maintenance contracts with suppliers (after the warranty period allocated in the contracts), consumables, after sales services and continuous staff training required for a medium and long-term operation of the radiology equipment.
•MOHP provided appropriate training facilities, arranged the travels for the trainees and took an active and leading role in the organization of training courses.
6-Maintenance and Technology Management
•MOHP assigned an official in charge of clinical equipment maintenance and technology management also supported the set-up of an information system for the equipment and material acquired in the frame of the Project.
7-Technical Assistance Program
•a Technical Assistance Program (TAP) through a grant this budget includes financing for administrative project implementation support as well as local and international expertise
•Contribution in for the operational costs of the training courses.
•The development, elaboration and review of the standard guidelines.
•Radiation Safety strengthening of radiation safety technique and practices and its monitoring by the relevant Egyptian authorities.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Output 1: Sites Rehabilitation: ESRP has rehabilitated sites in almost all the governorates of Egypt, we have renovated almost 45% of the radiology departments in all of the hospital types whether general, chest or fever hospitals. All the rehabilitated sites match exactly the defined standards by the project. Also MOHP follows these defined standards for rehabilitation in all the new renovated or newly established radiology departments
Output 2: Equipment procurement & Installation: ESRP supplied 385 different types of radiology equipments with their accessories and currently more equipments are being purchased to reach a total of 422. ESRP has also upgraded the types of equipments supplied from the mere analogue to full field digital equipments which was a great corner stone to start adopting the latest technology for radiology reporting which is the Picture Archiving & Communication System PACS as well as Tele-Radiology. Training was done on these new equipments to help in raising the levels of knowledge and awareness.
Output 3: Radiation Safety: An initial baseline assessment study was done which revealed a gap between what is applied in the hospitals and what the national standards are. Actions were taken through adopting modified international standards to fit the Egyptian culture and coming up with lists of recommendations, then applying these standards which caused the level of safety to be raised. Calibrations for equipments was done, radiation shielding was reconsidered, safety brochures and protection aprons were handed to the different hospitals
Output 4: Quality Assurance & Supervision Schemes: Baseline assessment was done and guidelines for the quality of radiology services were set and applied after training on these guidelines, this caused the level of service quality to be raised from an initial of 48%to 65%. Currently we are working on updating these guidelines to be able to be accredited.
Output 5: Maintenance & Technology Management: Lots of efforts were exerted in this output in many levels to enable us now to have a full plan where a tracking tool is present for the monitoring of equipments breakdowns, maintenance contracting and all other related information. MOHP has adopted this tool and now is following the standards set by the ESRP for this output.
| 8. What were the most successful outputs and why was the initiative effective?
ESRP succeeded in tailoring a system which monitors the project activities and tasks this system is web based called "Dotproject" which can only be accessed by the team members and management.
The system is a combination of color codes each reflecting the progress of each single task. The colors are like the traffic lights. The system has green light for the on-time and ongoing tasks. Yellow color is for the recently delayed tasks. And the red color is for the tasks far beyond the deadline of the plan or indicating no achievement.
In addition, there is a general meter where the overall project progress is indicated. This is useful for the project management to screen the percentage of activities progress with just one click. Moreover, it gives the decision makers the weakness sites with only quick one look.
Recently it was found that it would be more realistic and beneficiary to have a system where the project activities and tasks can be monitored and measured as well as the radiology departments' key performances and tasks.
The system is currently being upgraded to include the other activities of the radiology department. The monitoring system is a web based system to help the Swiss partner managers to follow up the project activities from their place and help in giving the decisions at once.
This way we overcame the time gap between sending the activities’ measures and the final agreed upon decisions. On the other hand, the system gives levels of permissions where all the team members can access and use it for their own activity and tasks.
The team member can monitor their own progresses as well. This supports the self corrections and is more responsible. The web based system also has a section for the files explorer. Such explorer has the option to link each single document to a task as output, deliverable or input. The project is currently working on updating the key performance indicators. This will lead to upgrade the monitoring system according to the latest updates.
This system also allows all members stay connected and updated with all new tasks as an automatic e-mail is generated and sent to all the involved parties as soon as a new event is created.
| 9. What were the main obstacles encountered and how were they overcome?
1-Political and governmental changes: so far almost 9 ministers were changed and a lot of governmental heads
We overcame this because we have a well planned design with malleability to different perspectives.
2-Shortage and sometimes no budget allocations: we overcame this by working on separate levels with the different governorates so that each one finances their hospitals till we succeeded in bringing the fund centrally from MOHP.
3-Tender problems: at the 1st tender issued one of the bidding companies complained and caused us to stop for 1.5 yr till the issue was solved, again due to our malleable plan we were able to stretch the time frame
4-Owing to the agreement with the Swiss partner we had to get 100% Swiss equipments and when assessing our needs compared to the specifications of the Swiss equipments there was a gap that could have potentially stopped the collaboration, we overcame this by convincing the Swiss part to reduce the Swiss added value or share in equipments manufacturing to only 49%.
5-Sometimes we face a conflict between ESRP plan and the whole MOHP plan like we both want to rehabilitate the same site, so we overcome such situations by suggesting that MOHP renovates the hospital but ESRP renovates the radiology department as we already have the guidelines for that, we always try to by find a way to have a win/win situation with MOHP .