Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696588509680.pdf (Vanuatu)
MINISTRY OF HEALTH ROLE DELINEATION POLICY ACKNOWLEDGMENT This policy paper reﬂ ects an extensive consultation process with stakeholders, both within and outside of the Ministry of Health (MOH).

Within the MOH this included senior executives, program managers, provincial managers, community health staﬀ , hospital clinicians, nursing staﬀ , allied health staﬀ , and corporate services representatives.
Beyond the MOH, it involved Development Partner (DP), Non-Governmental Organisation (NGO), Faith-Based Organisation (FBO) and Civil Society Organisation (CSO) representatives.

The content and principles of the Policy are based on the observations and ideas of the many people, and organisations, who have contributed to its development.

The MOH and Role Delineation Policy (RDP) Working Group wishes to express their gratitude and appreciation to all.
Speciﬁ c acknowledgement is extended to the World Health Organization (WHO) and Government of Australia for provision of technical advisory support through support arrangements, so as to enable the role delineation policy review to be completed in a timely fashion.
In particular, the MOH would like to recognise the Australian Volunteers for International Development (AVID), Phillipa Milne (Health Service Planning Consultant, WHO), and the Vanuatu Health Resource Mechanism (VHRM) for their technical advisory support.

ACKNOWLEDGMENT This policy paper reflects an extensive consultation process with stakeholders, both within and outside of the Ministry of Health (MOH).
Within the MOH this included senior executives, program managers, provincial managers, community health staff, hospital clinicians, nursing staff, allied health staff, and corporate services representatives.

Beyond the MOH, it involved Development Partner (DP), Non-Governmental Organisation (NGO), Faith-Based Organisation (FBO) and Civil Society Organisation (CSO) representatives.
The content and principles of the Policy are based on the observations and ideas of the many people, and organisations, who have contributed to its development.

The MOH and Role Delineation Policy (RDP) Working Group wishes to express their gratitude and appreciation to all.
Specific acknowledgement is extended to the World Health Organization (WHO) and Government of Australia for provision of technical advisory support through support arrangements, so as to enable the role delineation policy review to be completed in a timely fashion.
In particular, the MOH would like to recognise the Australian Volunteers for International Development (AVID), Phillipa Milne (Health Service Planning Consultant, WHO), and the Vanuatu Health Resource Mechanism (VHRM) for their technical advisory support.
2 ABBREVIATIONS Electrocardiogram Electroencephalogram Expanded Programme of Arterial Blood Gas Aid Post Antistreptolysin O Blood Pressure Communicable Disease Community Health Services Civil Society Organisations ABG AP ASO BP CD CHS CSO DNA Deoxyribonucleic Acid ECG EEG EPI Immunisation Emergency Department ED EDL Essential Drugs List EENC Early Essential Newborn Care Environmental Health EH Emergency Operations Centre EOC Emergency Medical Teams EMT Ear, Nose & Throat ENT Faith Based Organisations FBO Full Time Equivalent FTE GOPD General Out-Patients Department HDU High Dependency Unit HIS HIV HPU HSS ICU IUD INGO Organisation ISV LIS MOH Ministry of Health MICU Maternity Intensive Care Unit MO Medical Officer Health Information Systems Human Immunodeficiency Virus Health Promotion Unit Health Sector Strategy Intensive Care Unit Intrauterine Device International Non-Government Integrated Supervisory Visits Laboratory Information Systems Nurse Aide Paediatrics Intensive Care unit Primary Health Care MW Midwife NA NCD Non-Communicable Disease NICU Neo-natal Intensive Care unit NGO Non-Government Organisation NP Nurse Practitioner NPH Norther Provincial Hospital NRH National Referral Hospital NTD Neglected Tropical Diseases O&G Obstetrics and Gynaecology OPD Out-Patients Department PACS Picturing Archiving and Communications System PICU PHC PMS Performance Management System RDP Role Delineation Policy RP Rural Physician RN Registered Nurse RRH Regional Referral Hospital SBA Skilled Birthing Attendant SCN Special Care Nursery SHW Skilled Health Worker SMO Senior Medical Officer STI Sexually Transmitted Infection SV Supervisory Visits TB Tuberculosis Tables of Equipment ToE UHC Universal Health Care Vila Central Hospital VCH Vector Borne Diseases VBD VHW Village Health Worker VHWP Village Health Worker Program WASH Water, Sanitation and Hygiene WHO World Health Organization 3 ACKNOWLEDGMENT ............................................................................................................................... 2 Contents ABBREVIATIONS ...................................................................................................................................... 3 Appendices .............................................................................................................................................. 4 Purpose of Role Delineation ................................................................................................................... 5 1.
Background ..................................................................................................................................... 5 2.
Applicability ..................................................................................................................................... 5 2.1 Guiding principles for the Role Delineation Policy ................................................................. 7 2.2 Models of Care in Vanuatu ..................................................................................................... 7 2.3 2.4 2.5 Levels of care delivered through health facilities ................................................................... 7 Services and policy platforms for PHC delivery .................................................................... 10 Decentralisation .................................................................................................................... 10 3.
Resources ...................................................................................................................................... 11 4.

Definitions ..................................................................................................................................... 12 5.
The Policy ...................................................................................................................................... 13 5.1 5.2 5.3 5.4 Accessibility and Classification Criteria ................................................................................. 13 Health Services ...................................................................................................................... 15 Staffing Standards ................................................................................................................. 15 Functional Space ................................................................................................................... 16 5.4.1 Community Care Facilities............................................................................................. 17 5.4.2 Primary Care Facilities ................................................................................................... 17 5.4.3 Secondary and Tertiary Care Facilities .......................................................................... 18 5.5 5.6 Equipment ............................................................................................................................. 18 Supervision and Monitoring .................................................................................................. 19 Appendices A - Accessibility and Classification Levels B - Health Services C - Staffing Standards D - Functional Space Requirements E - Minimum Essential Equipment 4 Purpose of Role Delineation Role Delineation is a tool that is used in many countries to describe and define their health facilities and services.
A Role Delineation Policy (RDP) should: ……clearly define the roles of different levels of health facilities and identify the relationships between these.

This includes defining essential service packages for primary care facilities.

The RDP should also provide a basis for linking service planning to population, taking account of geography and isolation factors1.

1.
1.

Background This Role Delineation Policy (RDP) draws on the policy developed in 2004, and the review conducted from 2017 to 2018, to identify the minimum package of services that should be delivered through all health facilities in Vanuatu.
This policy also identifies the staff requirements – skills, qualifications and experience - to deliver these services, and the facility functional space, utilities and equipment requirements to support safe and effective delivery of clinical and public health services.
The Ministry of Health (Vanuatu) has lead responsibility for many traditional public health functions, (EPI), including, communicable disease prevention, Expanded Package of environmental health and food safety regulation and also provides, funds and manages a wide range of preventive healthcare, health promotion and disease prevention programs, and screening initiatives.
Immunisation Alongside private health providers, the Ministry of Health takes the lead in providing curative care services to the people of Vanuatu, including: emergency and critical care; medical services, surgical services, maternal and reproductive health services, newborn and adolescent services, mental health services, and allied health & clinical support services.
In additional to public services provided the MOH also has established management, general support services and education, training and supervision services for clinical service delivery.

This RDP focusses on those activities that the Ministry of Health (Vanuatu) fully funds or sponsors, and articulates the Ministry’s expectations for the delivery of these functions through the complete Model of Care.
However, the health system is made up of ‘all the activities whose primary purpose is to promote, restore and/or maintain health2 and there are many organisations outside government that make a very significant contribution to improving the health of the population including Faith Based Organisations (FBOs), Non-Government Organisations (NGOs) and other Civil Society Organisations (CSOs).
This RDP will assist collaboration across sectors to assess the unmet needs, and ensure people’s equitable access to health resources delivered in accordance with national standards.

A full list of the MoH policies, legislation and references used in the review and development of this policy can be seen in Section 3: Resources.

2.
2.

Applicability The Health Sector Strategy (HSS), 2017- 2020 has recommended a review of the 2004 RDP as one of the actions required to strengthen service planning and improve resource allocation.
The RDP, once established will become the aspirational standard for provision of health care services in Vanuatu, 1 Health Sector Strategy, 2017-2020 2 World Health Organization, Health Systems Strengthening Glosssary, http://www.who.int/healthsystems/hss_glossary/en/index5.html, sighted on 14th December 2017 5 guiding planners and implementers to provide functional space, equipment fit for purpose and trained human resources in order to offer a defined package of essential services at every level.
Desired outputs of the policy are to: - Define health services to be provided at primary, secondary and tertiary care levels - Define designations of health facilities within each care model, reflective of access by population and proximity to higher level health facilities - Define staffing levels, skills, qualifications and experience for health providers to match the health services - Define minimum functional space requirements and utilities, reflective of facility designations - Define minimum equipment requirements for provision of safe and effective health services - Reflect consideration of gender and vulnerable groups, inclusiveness, sustainability, climate change and disaster risk.
Objectives of the MOH in utilizing this policy framework are: - - - Improve equitable distribution of health facilities with consideration to population catchment and access to health services Strengthen health service delivery through appropriate assignment of trained health professionals and support staff Improve facility infrastructure and provision of essential equipment This RDP can be utilised: - By communities who are able to see the range and quality of services they should expect - By health sector staff to help assess their own performance and that of their health facility.
- As planning guidelines by national and provincial health planners to help assess the unmet needs of the population, and establish plans to bring services up to minimum acceptable levels.

- By government to determine annual development priorities and guide resource allocation3.
This RDP is to be used in the preparation of operational National and Provincial Health Service Plans to set priorities for working towards equitable delivery of services and service improvement within provinces and nationally for the period 2017 – 2030, in line with the National Sustainable Development Plan (NSDP).
This would include strategies for achieving an incremental increase in staff resources and demonstrated equitable distribution of health professionals, and subsequent services delivered, throughout the country.

Strategies may include use of contracts and potentially partnerships with other sectors (Including FBOs, NGOs and CSOs).

Principles set out in the HSS (see section 2.1 Guiding Principles) will guide planning and decision- making.
For example, determining priorities for incremental increases in services by using data, such as: population densities4 and information on health needs and service utilisation through the Ministry’s Health Information System (HIS).
3 Service delivery packages for Solomon Islands primary care services, 2016 4 World Bank’s Community Health Services (CHS) 2016 Expenditure Analysis (Vanuatu) 6 The HSS 2017 – 2020, envisages a health system based on the following principles: Guiding principles for the Role Delineation Policy 2.1 - Universal Health Coverage (UHC) – ensuring that all citizens have equitable access to affordable health care, including emergency, curative and rehabilitative services, regardless of their age, gender, race, socio-economic status or where they live.
- Primary Health care (PHC) is the foundation of the health system and remains the core strategy for addressing most health issues.

- Responsibility for health requires multi-sectoral action – including partnerships with other government agencies, development partners, FBOs, NGOs, the private sector and other CSOs.

- Health services should be ‘people-centred’ and inclusive, the needs of disadvantaged and vulnerable populations, those with disabilities and victims of violence, must be addressed.
- The health system should provide a continuum of care, through integration of public health and curative services.

This means that a practical referral system should exist to make sure that people can access higher levels of care as needed and receive follow up.

- Health services should be high quality, and delivered in a cost–efficient way by staff with recognised skills and qualifications.
- Advocacy and active community engagement is important in encouraging communities and individuals to be responsible for their own health.

This extends to collective participation through management of health facilities.

The establishment of a functioning health committee, constituted of interested and informed community members, is an example of how this collective involvement can take shape.

- Health service planning, development and delivery must be evidence-based.
In turn, we must monitor and evaluate the way we deliver health services, so we can keep building the knowledge base to guide future service development.

In additional to these principles outlined in the HSS, additional consideration for the following are to be made: - promoting gender equality and empowering women, - disability inclusion, - - child safeguarding, and climate change and disaster risk.
2.2 Models of Care in Vanuatu This section describes the system of delivery at the community care level through to the tertiary level through health facilities in Vanuatu and is sometimes referred to as the ‘Model of Care.’ Again it focuses on the Ministry’s service delivery functions, recognizing there are many organizations outside government making a very significant contribution to improving the health of the population.
The levels of care provided through the facilities that are the subject of this RDP are illustrated 2.3 below in Figure 1.

Levels shown correspond to the policy definition which are further described in Appendix A.
Levels of care delivered through health facilities Individual levels may include multiple sub-levels, such as for Dispensary (inclusive of Remote Dispensary level 5b) and Health Centre (inclusive of Enhanced Health Centre – Level 4b): 7 Figure 1: Levels of care provided by Aid Posts, Dispensaries, Health Centres and Hospitals Aid Post (Level 6) Dispensary (Level 5) Health Centre (Level 4) Provincial Hospital (Level 3) Regional Referral Hospital (Level 2) National Referral Hospital (Level 1) Health education, prevention of communicable and non communcable diseases, sanitation, mother and child care, treatment of simple medical problems.
Health education, prevention and control of communicable diseases ad non communicable, maternal and child care, immunisation, screening early diagnosis and intervention, treatment of common diseases and injuries.

Provide enhanced level of primary care.

More specific expertise available in maternal and child care.

Specialized care through outreach/mobile specialists.
Provides general medical care, diagnostic services, limited surgical procedures and access to specialist consultation for patients referred from primary health care facilities as well as a local catchment.
Provides general medical care PLUS specialist diagnosis, treatment and management of more serious/complex conditions in patients referred from a number of provinces As well as a regional referral role, the National Referral Hospital, providing a range of more highly specialised diagnostic and treatment services [eg management of major trauma; complex surgery and obstetrics, cardiac investigations, intensive care and rehabilitation services] for patients referred nationwide.
Community care Primary care Primary care Secondary care Primary Care Secondary Care Secondary Care Secondary Care Tertiary Care Tertiary Care It is to be noted that due to the geography of Vanuatu and topography of islands within the Vanuatu Archipelago, additional definitions are used to describe primary care facilities in remote locations or with enhanced services, normally associated at Dispensary Level (I.e Remote Dispensary) or at Health Centre Level (I.e Enhanced Health Centre).
Secondary care services, including acute care of a serious injury or period of illness, usually relatively urgent are currently provided through provincial hospitals in six provinces (SHEFA, SANMA, TAFEA, PENAMA, MALAMPA and TORBA).

While SANMA and SHEFA facilities have other titles, as Regional Referral and National Referral Hospitals respectively, they share their higher-level function with concurrent roles as provincial hospitals to their local provincial population.
Tertiary Care is highly specialised health care, often for inpatients and on referral from a primary or secondary health services, and often includes particularly complex medical or surgical procedures.

These services are provided solely through the Regional and the National Referral hospitals located in SHEFA and SANMA provinces.
The Northern Provincial Hospital (NPH) located in SANMA is listed as a Regional Referral Hospital for Northern provinces and Vila Central Hospital (VCH) as the National Referral Hospital for the country.

The Model of Care in Vanuatu assumes that people can access higher levels of service as needed and receive follow up care through a referral pathway that connects Aid Posts, Dispensaries, Health Centres and Hospitals.

These relationships are illustrated below in Figure 2.
Each level of service includes the services of the level below it but adds a higher level of complexity.

Referral pathways need to remain flexible ensuring that adults and children with more serious needs can be referred to receive treatment in centres with the appropriate facilities and expertise in order to maximise their chances of survival.
It should be noted that for referral pathways, there is no 8 additional designation to Dispensary or Health Centre level facilities (such as ‘Remote’ or ‘Enhanced’ titles).
Figure 2: Model of Care (Vanuatu) Secondary / Tertiary Care Secondary / Tertiary Care Supervision / Outreach National Referral Hospital Regional Referral Hospital Primary / Secondary Care Provincial Hospital Provincial Hospital Provincial Hospital Primary Care Health Centre Health Centre Primary Care Dispensary Dispensary Dispensary Community Care Aid Post Aid Post Aid Post Referral Pathway Note: The illustration above is not reflective of the number of health facilities in Vanuatu nor any limitations on the number of sub-ordinate facilities that link to higher-level facilities.
The role of Provincial Management teams, inclusive of Provincial Administration, Public Health Management and Hospital & Curative Services Management groups, is to provide provincial health service delivery through conduct of integrated planning, provision of administrative support required to maintain fixed site services, provision of surge support to fixed sites and provision of outreach or other mobile services.
Provincial Management teams are to plan and coordinate integrated service delivery within the province, inclusive of those services provided through implementing partners external to the government, in consultation with all stakeholders.

Oversight of primary care referral systems is to be provided by the Provincial Health Services Manager and, where required, administrative support is to be provided to rural health nurses and doctors for movement of patients to secondary and tertiary facilities.
Hospital Management teams, led by the Medical Superintendent, are responsible for supporting service delivery within the hospital and for provision of support to Public Health Managers in the delivery of integrated health services, planning of health service outreach and for support to rural nurses / doctors for the coordination of referral cases.
Within the Province, supportive supervision and Integrated Supervisory Visits (ISVs) are to be planned by Provincial Management teams and conducted by provincial staff down to all levels of Primary Care facilities.

This may also include national Public Health, Hospitals & Curative or Corporate Service representation in the composition of any supervisory team.
9 2.4 The eight key elements of effective Primary Health Care5 are used as a guiding framework to describe services to be delivered at each level of care and by each type of health facility.

The policies and guidelines for the delivery of these services are developed by each of the Ministry’s public health programs.

Services and policy platforms for PHC delivery Eight key elements of effective Primary Health Care: 1.
Health Promotion and mobilisation/participation the Principles of and Primary Health Care; community 2.

Maternal newborn and child health (aged 0-5).


This includes reproductive health and vaccine preventable diseases) Child and adolescent health (aged 5-17) Food and nutrition Environmental health and water, sanitation and hygiene (WASH) Endemic communicable diseases (assessment, diagnosis, management and referral) Non-communicable diseases (prevention, management and/or referral) Provision of essential medicines 3.

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8.

A Healthy Islands policy provides the platform for enabling action across and within settings to address health priorities using a primary health approach.

In Vanuatu these settings are: Healthy Villages; Healthy Schools, Healthy Markets, and Healthy Clinics.

A focus on settings enables comprehensive action in a particular location (school, market and village clinic) to improve health.
The MOH Healthy Islands policy, 2016, provides a strategic direction for the application of primary care as a tool for achieving the vision of healthy islands.

This policy is in line with the Framework of Action for Revitalization of Healthy Islands in the Pacific, endorsed by Pacific Health Ministers in 2011.
2.5 Decentralisation The model of care in Vanuatu is influenced by legislation, particularly the Decentralization Act (1994), which provided for the creation of the present six provinces and the devolution of health care service provision (preventive, curative and rehabilitation) to provincial health care administrations.
The establishment of an appropriate network of supervision at all levels of health service provision is regarded as an important component of the decentralization of health services6 which is provided through integrated supervisory visits, clinical supervision and performance management appraisal systems.

Table 1 below shows the current distribution of facilities by province.

Aid Posts are owned and managed by the local community.
The Dispensaries and Health Centres listed in the table are government owned and managed facilities.

The bracketed numbers refer to facilities that are open7.
Table 1: Health Facilities by Province (2016) (Source: VanVis2) Province National Referral Hospital Regional Referral Hospital Provincial Hospital Health Centre Dispensary Aid Post TORBA SANMA PENAMA - - - - 1 - 1 08 1 3 8 (8) 6 (6) 5 18 (16) 23 (22) 24 49 40 5 Declaration of Alma –Ata, 1978, World Health Organization, (WHO) 6 Ministry of Health Policies, 2004 7 MOH, Planning Unit, Health Facilities data set (August 2017) 8 Northern Provincial Hospital (NPH) designated as Regional Referral Hospital 10 MALAMPA SHEFA TAFEA TOTAL - 1 - - - 09 - - 1 010 1 6 9 (9) 5 (5) 4 (3) 34 (33) 19 (18) 13 (12) 13 (11) 91 (84) 47 45 40 245 Hospital facilities located in SANMA and SHEFA Province, while maintaining a dual role as provincial hospitals, are shown in their higher designation as regional referral and national referral hospitals respectively.
Further detail on government health policy in regards to devolution of health services, resource allocation and user fees, are described in the Ministry of Health Policies, 2004.

Reprinted in 2016, this document is still relevant today in describing the Model of Care.
These policies indicate a commitment to devolve health service functions to all areas of Vanuatu in accordance with the principles of access, equity and health needs and to pursue preventative health practices as a priority in order to create a more effective health system, a commitment renewed in the recent HSS, 2017- 2020.
In line with this commitment to achieve UHC, the Ministry’s policy statement on user fees (2004) states that “fees, if applied, should not deter an individual’s access to services and in particular should not obstruct the development of strong preventive health services”.

While not to be defined in this policy, the presence of private health care facilities and those run by municipal councils are acknowledged for the support and burden they share within the Model of Care.
Further classification and regulation of services provided by other parties is to be completed by the MOH with relevant partners, so as to ensure that health service provision and standard of care are well regulated and compliant with expected levels of services with mutual support provisions clearly outlined.

3.
3.

Resources The following is a list of resources that link to the RDP: - National Sustainable Development Plan, 2016 - 2030 - Health Sector Strategy, 2017 – 2020 - Ministry of Health, Organization Structure, 2017 - Ministry of Health, Role Delineation Policy, 2004 - Ministry of Health, Medical Equipment Donor Policy, 2002 - Draft review of Ministry of Health’s Role Delineation Policy undertaken in 2015.
- Village Health Worker (VHW) Scope of Practice, 2016 - The Competencies Standards and Indicators for Registered Nurses in Vanuatu, Vanuatu Nursing Council, 2011 - Decentralisation Act (1994) - Health Committees Act (2003) - World Health Organization (WHO) Health Resources Availability Monitoring System (HeRAMS) http://www.who.int/hac/herams/en/ - Ministry of Health Policies, 2004 (re printed 2016) - Role delineation polices of Solomon Islands, Fiji and Papua New Guinea.
- Employment Act (Consolidated 2006) 9 Vila Central Hospital (VCH) also acts as Regional Referral for SHEFA / TAFEA Provinces 10 VCH is provincial Hospital for SHEFA Province 11 - Public Service Act (Consolidated 2006) - Public Finance and Economic Management Act - Financial Regulations (1999) - Health Practitioners Act - Mental Health Act - Nurses Act - Sale of Medicines Act - Control of Medical Practice (Joint Regulation) - Public Health Act 4.
Definitions Code of Practice Level of service delivery expected to be carried out by any individual in accordance with their title as supported through their formal training and registration.
Community Engagement The process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being.11 Decentralisation The act of giving the means (through governance framework, structure and resources) for services to be planned and implemented at provincial level Fixed Site Visit Functional Space Home Visit Integrated Supervisory Visits Model of Care Outreach Visit to a static (permanent) site by a patient for diagnosis or treatment.
Fixed sites may result in being considered outpatient (no requirement to stay overnight) or requiring inpatient services.

The spatial requirements within a health facilities based on the services to be provided based on the designation of the facility.

Includes the space required for staff to provide health services, and housing for all health equipment.
Home Visits by Medical Personnel are individually designed services to provide diagnosis, treatment and wellness monitoring in order to preserve the participant's functional capacity to remain in his/her own home Visits conducted by multiple managers, public health programs and other corporate functions, reviewing administration, public health outputs, essential medicines stocks, infrastructure and equipment states, normally resulting in plans to address administrative or operational support deficiencies or other training and development opportunities for staff.
Broadly defines the way health services are delivered.

It outlines best practice care and services for a person, population group or patient cohort as they progress through the stages of a condition, injury or event.

Outreach is an activity of providing services to any populations who might not otherwise have access to those services.
A key component of outreach is that the groups providing it are not stationary, but mobile; in other words they are meeting those in need of outreach services in the patient’s current location.

Primary Health Care Health care provided in the community for people making an initial approach 11 Community engagement, p.g.
9 https://www.atsdr.cdc.gov/communityengagement/pce_what.html 12 to a medical practitioner or medical facility for advice or treatment Supportive Supervision A process of guiding, helping, training and encouraging staff to improve their performance to provide high quality health services.12 Supervisory Visits Visits conducted by managers, national / provincial program staff or appointed supervisors of subordinate officers and facilities, in order to provide supportive supervision, often resulting in provision of additional resources or individual training.
Table of Equipment The confirmed minimum type and quantity of equipment, considered fixed assets and inventory items, dependent on the designation of the facility.

Universal Health Coverage Village Health Worker Program Ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship.
The informal health system utilising the Community Care model of care with services provided through volunteer Village Health Workers (VHWs).

Managed and implemented by the Ministry of Health at national and provincial levels through Health Promotion Units (HPUs).

5.
5.

The Policy In the development and maintenance of Government health services across the full Model of Care, the Ministry is to consider accessibility, services requirements, resource availability; particularly staffing, financing and availability of physical infrastructure, as well as the development of support systems such as supervision, administration, monitoring and communication.13 It is not intended for this RDP to govern the provision of health services by private practices.
However, any development and provision of health services by external providers, where there is intention to transfer responsibility to the Government of Vanuatu for continued provision of those services or draw on government resources to provide services to the general public, should be done with due consideration to the RDP content.

Population catchment figures and locational access criteria for Primary, Secondary and Tertiary Care facilities are detailed in Appendix A.
Accessibility and Classification Criteria 5.1 Community Care facilities (I.e Aid Posts) are not owned by the Government of Vanuatu or Ministry of Health however the MOH will provide advice on placement due to management and operations of the VHWP being a MOH responsibility.
Considerations for AP site / facility establishment are: - Land approved to be provided by the community for the purpose of delivery of community health care services under letter of agreement; - Area big enough to accommodate functional space and outdoor educational areas; - Meets population catchment and accessibility requirements as per Appendix A; - Able to link with primary care network; 12 Supervising Healthcare Services (Improving the Performance of People); JHPIEGO; 2004 13 Service delivery packages for Solomon Islands primary care services, 2016 13 - Have a qualified VHW available to carry out services (or intention of the MOH to place a qualified VHW in the location); and - Have access to reliable means of communications for referral and management services.
Evidence supports the need for a targeted approach to ensuring more equitable delivery of services across provinces.

The World Bank’s Community Health Services (CHS) 2016 Expenditure Analysis, Vanuatu can identify, for populations living in each Province and in Health Zones, the: - Distribution of health care facilities; and - Distribution of skilled health workers.
This information will be used by the MOH to identify where resources should be allocated to move to more equitable distribution of health services, informing implementation of the RDP in line with its guiding principles, and any future budget submissions to the Government for payroll, operations and Capital expenditure.
As a minimum, planning changes to services or location of new services, across Primary, Secondary and Tertiary settings, will need to take account of: - The size of the population for the area to be serviced within a defined catchment area; - The proximity of the population within the catchment areas and access time to the health facility; - Clear identification of those areas within the catchment area that may be in need of outreach services; - Ease of access to the next level of care taking into account remoteness and mode of transport available; and - Infrastructure and equipment available to ensure exchange of information between facilities and support to timely referrals or outreach requirements.
Before any health facility is established or upgraded, the site/facility is to be checked against the following list of requirements: - - Land is State land OR has a valid lease agreement OR has an agreement to lease OR discussions have started to have a lease established; Size of land parcel available is sufficient to support the intended facility; - Application of standards and considerations as outlined in Appendix A; - Modes of transport available to access facility from within catchment area; - Ability to link with higher health network through different modes of air, sea or land transport without major infrastructure development; - Access to reliable water supply or ability to access water resources with minor works; - Located in a manner so that the safety and security of staff, their families and possessions are not at risk; - Access to suitable staff housing in the community or ability to construction staff housing within the health facility boundary without major modification; - Access to reliable means of communication; - Ability to link with existing power supply or have access to alternate power supply; 14 - Vulnerability to climate change risk or natural disaster; - Ability to provide gender protection in the delivery of services through location or associated infrastructure; and - Ability to accommodate inclusive design requirements.
For any new facility to be established or any existing facility to be upgraded (or downgraded), the MOH is to carefully consider the ensuing effect on health services, financial support requirements and HR planning, and to obtain an approval through an established health facilities management framework.

Health Zones are to be clearly defined and, where possible, align with Area Council delineations.
In all cases, zoning is to utilise clearly identifiable features or existing boundaries, such as coastlines, water tributaries, or ridgelines in order to delineate zones.

Health zones, facilities and services provided at each are to be mapped geographically and up to date records held for access by MOH and external partners.
Health facilities are to have unique identifiers, be reflected by classification name and level, and have correct information held relating to facility name, health zone, functional space available, equipment available and human resources posted.

5.2 Health Services Each level of service includes the services of the level below it but adding a higher level of complexity of care.
An effective referral and follow-up system between levels of care is needed to ensure that appropriate care is available wherever it is required, and linked, where necessary, to other levels of care.
For example, it is important for maternal survival, since timely linkage to referral-level obstetric care is necessary to reduce maternal mortality.14 The service packages to be delivered by each facility are detailed in Appendix B1 and B2 for primary care services and core requirements and Appendix B3 for hospital facilities for hospital services and core requirements respectively.
These service packages are designed to encourage links between services, for example, communicable disease programs Vector Borne Diseases (VBD), Tuberculosis (TB), Sexually Transmitted Infection (STI), Neglected Tropical Diseases (NTD)) and Environmental Health (EH) activities; and links between reproductive health, maternal, newborn and child and adolescent care.
Mechanisms such as Integrated Supervisory Visits (ISVs) and programs such as the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) and the Integrated Management of Childhood Illnesses (IMCI) program are mechanisms for achieving service integration.
Within Hospital Services tiered capabilities are more evident within allied, medical and dental health services due to the reduced numbers of facilities across the country, which have an effect on skilled human resources, and both functional space and equipment requirements.
Staffing standards are determined on the basis of the: 5.3 - Staffing Standards The types of services to be provided different levels of health facility; 14 Continuum of care for maternal, newborn, and child health: from slogan to service delivery, Lancet 2007; 370: 1358–69, K J Kerber MPH, J E de Graft-Johnson MD, J E Lawn MRCP.

15 - - Limitations of code of practice for each level of health professional; and Expectations for mobile outreach and supervision.
For Primary Care facilities, staff requirements are summarized in Table 2 below.

A detailed description of the staffing requirement for all facilities and relevant code of practice as it relates to health services is provided in Appendix C1.
Table 2: Staffing Levels and Primary Care Facilities Facility Aid Post Dispensary Remote Dispensary Health Centre Required staffing Village Health Worker 15 Registered nurse Nurse Aide Midwife Nurse Aide Nurse Practitioner Midwife Registered Nurse Nurse Aide Handy man and Driver Enhanced Health Centre As for Health Centre, plus: Rural Physician Within Secondary and Tertiary facilities the planning is more complex and needs to consider patient loading, bed availability, occupancy rates and services provided at the facilities in question.
As such, minimum staffing levels have not been defined for Hospitals, however planning information has been included at Appendix C2 for future use in workforce planning.

Based on 2015 population and workforce data, Vanuatu has a ratio of 14.6 skilled health workers (doctors, registered nurses and mid-wives) to 10,000 population (Health Sector Strategy, Ministry of Health, 2017), which is well below the recommended World Health Organization (WHO) ratio of 24 skilled health workers to 10,000 population.
Recently, WHO has revised this to 44.5 skilled health workers to 10,000 population, however caveats remain that these density figures need to be considered in the context of the country.

It is estimated that a ratio of 38.16 skilled health workers to 10,000 population, based on population projections for 2030, would be required to meet the skilled health worker requirements of this Role Delineation which is aligned to the MoH’s Organizational Structure for 2017 – 2030.
The Ministry aims to increase its skilled health workforce, including a target of 24 skilled health workers to 10,000 population by 2020 (HSS, 2017).

The resources needed to achieve this increase indicate some extra 265 skilled health workers would be needed to achieve the target of 24 to 10,000 based on current workforce data and population figures16.
It is vital then that resources are allocated where they are most needed to ensure more equitable access to health services within provinces and nationally for the period 2017 – 2025.

Functional space is determined on the basis of: Functional Space 5.4 15 A VHW is appointed by the local community to provide informal care.

The Ministry provides training and some eqWateruipment and supplies.
16 Estimates provided by World Bank, based on Ministry of Health workforce data (Source FMIS, 2017) 16 - Services to be delivered, - Number of staff operating within facility, - - Equipment and utilities required to provide services, and Physical planning data, workflow and ergonomics.
All functional space designed for new construction, extension, renovation and repair of health facilities is to consider (at minimum): - Efficient work flow practices, particularly minimizing time lag for patients to be seen by health professionals, - Compliance with national standards, or regional standards where national standards do not exist, - - Inclusive design criteria for both health services provider and patients and be respective of patient privacy, Protection of patients in the care of health workers within the boundary of a health facility, particular those vulnerable groups which could be at threat from continued domestic violence, gender-based violence or other violent or sexual assault, and - Safety provided to staff from hazards, disasters and other threats.
5.4.1 Community Care Facilities Aid Posts are not owned or managed by the Government however they do provide functional space for the VHWs to provide health services to the community.

Where dedicated space is not provided, VHWs can utilise space available at schools, FBO facilities and within other community infrastructure.

Minimum standards for function are: 1.

Ability to consult individual or accompanies patients in secure environment.

2.
2.

Ability to provide minor treatment and advice in a private area.

3.

Ability to store pharmaceuticals and equipment.

Based on the health services to be provided at each level of community and primary care, a functional space list (Appendix D1) has been provided for consideration of special requirements for inclusion in future standardised designs.
Primary Care Facilities 5.4.2 Dispensaries, Remote Dispensaries, Health Centres and Enhanced Health Centres are expected to meet the following support infrastructure requirements in addition to minimum standards for functional space requirements – - Water supply - tanks, standpipe or mains supply, with piped water and hand washing facilities in all clinical areas.
- Waste Management – ability to manage grey, brown and biomedical waste on site of have access for removal and back-loading to suitable disposal sites - - - Power supply for fridge, lighting and staff housing – solar, standby generator and / or mains.

Suitable sanitation arrangements to support the requirements of the facility, including a septic pit for disposal of placentas etc where relevant.

Security fencing with a gate.

Fence should be adequate to protect staff and buildings.
17 - Good ventilation and temperature control achieved by means of site selection and the orientation, design and construction of the facility.

- Insect screening to all areas.

- Good lighting (preferably solar) in all clinical areas.

- Staff housing – houses of standard design (including water tank, power and lighting), to reflect required staff numbers.
Based on the health services to be provided at each level of secondary and tertiary care facilities, a functional space list (Appendix D2) has been provided for consideration of special requirements for inclusion in future designs.

Secondary and Tertiary Care Facilities 5.4.3 The policy will not prescribe a standardised design, noting that review of the existing infrastructure and addressing gaps will need to be site specific.
The guidelines provided at Appendix E1 and E2 define minimum standard requirements for all facilities by type and are not to be taken as maximum functional space areas or restrictive for those facilities where additional space is required.

This is because capacity, and therefore the size of larger health facilities, needs to be determined on a more individual basis and will depend on the demand for services at each site across the country.
This means assessing actual and likely levels of utilisation, which usually links directly to the size of the catchment population and the range of services available at the health facility.

Further work may be done by the MOH in order to develop standardised designs for all levels of health facilities and show progressive, modular modification to allow for upgrading of facilities as is required from time to time.
In additional to support infrastructure considerations listed above for primary care facilities, the following should be available: - Water supply - Dedicated storage, treatment (where required) and reticulation to all essential services.

Storage – dedicated storage for supply management and consumable support services.

- - Waste Management – Contained treatment for medical waste (including laboratory reagents), separated septic or waste treatment system and biomedical hazardous waste disposal facilities.
- - Power supply – dedicated power supply with standby available.

Security fencing with a gate.

Fence should be adequate to protect staff and buildings.

- Good ventilation and temperature control achieved by means of site selection and the orientation, design and construction of the facility.

- Insect screening to all areas.

- Adequate Cyclone protection for all essential services.

- Good lighting (preferably low power energy efficient) for provision in all clinical and administration areas.
- Staff housing – houses of standard design(s) (including water tank, power and lighting), to reflect required staff numbers.
Equipment to be provided at each level of health facility has been determined based on: 5.5 Equipment 18 - - - - - The health services to be provided at the facility level The requirement for outreach services from the health facility The number of health professional and trained state for the provision of services and utilization of equipment Functional space available for safe and proper storage of the equipment Sustainability of the equipment type through supply systems of the MOH - Reduced lines of supply from external organisations - Configuration management, cannibalization and interchangeability of parts and powering systems Within Primary Care, Tables of Equipment (ToE) have been defined for each level of health facility in Appendix F1 and are reflective of minimum standards of equipment required to deliver the health services at each level.
The numbers of items required may need to be expanded in some cases for larger facilities with additional staff.

Additional specifications for equipment have been included to assist the MOH with future procurement requirements and, where warranted, preferred branding has been annotated.

For Primary Care facilities, additional non-medical equipment lists are included, such as the provision of transport, furniture, bedding, storage, computing systems, power systems and cleaning equipment.
This list is not exhaustive however should also be referred to for a minimum holding at each Primary Care facility.

For Secondary / Tertiary Care facilities the listing of non-medical items is more complex, due to the fact that facilities are not standardised.

While there are some items listed which provide additional utility to the provision of health services, the listing is not exhaustive and should be developed specific to each facility and the services that are provided.
As such, Appendix F2 focuses on defining minimum medical equipment that should be available at different levels of hospitals without defining branding or developing additional specifications for future procurement.

The minimum number has not been prescribed as this is dependent on service capacity required, staffing and functional space with support infrastructure which should be sit specific.
Any specifications of medical equipment should be confirmed prior to procurement as described by any relevant medical service strategies or Capital procurement plans.

Future work may be conducted by the MOH towards standardising the naming of all equipment (medical and non-medical) in line with regional or international naming standards so as to improve purchasing, inventory and asset management, and repair parts / maintenance systems.
Supervision of health professionals, monitoring of health services provided in accordance with code of practice and communications to and from provinces are all important components of managing Supervision and Monitoring 5.6 19 quality health service delivery.

While important at all levels, within hospital settings, supervision and monitoring is a requirement for maintaining and up-to-date Quality Management System (QMS).
Within the Primary Health Care space, supportive supervision objectives are: - - - - - To improve the consistency and standard of PHC delivery at health facilities; and To improve accountability between levels of care and health service management; To improve community trust in PHC services, through increased communal engagement and utilization; To provide timely and actionable feedback to health workers on PHC delivery and areas for improvement; and To provide follow up support on actions and areas for improvement.
Irrespective of the programme or level of care, supervision should support the delivery of health services that are safe, effective, timely, efficient, equitable and people-centred17 which are the principles of care (Refer to Table 3).
Table 3: Principles of Care Requirement Description Safe Effective Timely Efficient Equitable Delivering health care which minimises risks and harm to service users, including avoiding preventable injuries and reducing medical errors Providing services based on scientific knowledge and evidence-based guidelines Reducing delays in providing/receiving health care Delivering health care in a manner which maximises resource use and avoids wastage Delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status People-centered Providing care which takes into account the preferences and aspirations of individual service users and the cultures of their communities Principles to be followed in the conduct of regular supervision and monitoring are as follows: - Managers at all levels are to conduct proactive management of subordinates for collective targets, professional development requirements, and agreement of performance performance assessment against targets.
- The chain of command within the unit / departmental or directorate structure is to be respected at all times throughout the conduct of supervision and / or monitoring activities.

- Regular supervisory contact is to be made between superior and subordinates, for understanding on health service gaps and recommended solutions.

- Professional development of development opportunities, are to be encouraged and supported by the organisation.
individuals or groups, through range of learning and 17 Tuncalp, O, Were, WM, MacLennan, C, Oladapo, OT, Gulmezoglu, AM, Bahl, R, Daelmans, B, Mathai, M, Say, L, Kristensen, F, Temmerman, M, Bustreoc, F, 2015.

Quality of care for pregnant women and newborns—the WHO vision.

BJOG 2015;122:1045–1049.

20 - - - Supervisors are to maintain a professional relationship with subordinates regardless of sex, religious beliefs, employment status or otherwise.
Supervisory frameworks are to be established and supervision activities to be well planned, well integrated with multiple programmes (where possible) and reflective of contextual review requirements for systems strengthening.
Supervisory visits to primary care facilities are to be conducted on a 6-monthly basis, wherever possible, gathering information on health services provided, routine management services and itemized deficiencies as mapped against the RDP, staff code of conduct and other legislative or regulatory requirement.

- At PHC level, the zonal health centre in-charge should be engaged in supportive supervision visits to PHC facilities within his/her catchment area.
- Supervisory visits and monitoring activities are to be recorded and submitted to the appropriate level for oversight, action and archiving.

- QMS within hospital facilities are to be up-to-date, maintained with designated officers responsible for reporting on health services on at least an annual basis.
- Where endorsed by the relevant Director, external agencies may provide additional supervision and monitoring of health services provided, with subsequent reporting for recommended action by the MOH for systems strengthening.
21 APPENDIX A: ACCESSIBILITY AND CLASSIFICATION LEVELS 22 Level Name of Facility Abbreviation Classification Description 6 Aid Post AP An Aid Post is a facility established for the provision of Community Care within a health zone: APPENDIX A: ACCESSIBILITY AND FACILITY CLASSIFICATION LEVELS Planning Baseline: • Catchment population = 100 – 300 people • 80% of people in the catchment area can access the facility within 30mins (by the most common mode of access eg walking, paddling, truck etc) • Access to Dispensary may require land or sea transport services (Transport assets not held at AP level) • Not responsible for supervision of any other health facilities or health workers 5a Dispensary D A Dispensary is located within a health zone and has direct oversight of Aid Posts within its population catchment.
Planning Baseline: • Local catchment population = 300 – 2,000 • 80% of people in the catchment area can access the facility within one hour (By the most common mode of access eg walking, paddling, truck etc) • Access to next highest health facility within 1-4 hours (By the most common mode of access) • May be varied (ie for smaller population or less activity) • Responsible for oversight of Aid Post and Village Health Workers (VHWs) 5b Remote Dispensary RD A Remote Dispensary is located within a health zone and has direct oversight of Aid Posts within its population catchment.
It is remote in nature due to the time and method of travel required to access the next highest level of health care.

Planning Baseline as for Dispensary level except: • Access to next highest health facility within 2-4 hours (By the most common mode of access) 4a Health Centre HC A Health Centre is located within a health zone and has direct oversight of Dispensaries within its population catchment.
Planning Baseline: • Catchment population = 2000-5000 population including referral catchment • 80% of people in the catchment area can access the facility within 4 hours (by the most common mode of access eg walking, paddling, truck etc) • People in the catchment area would need to travel four (4) hours or more (by the most common mode of access eg walking, paddling, truck etc) to visit an alternative HC or Hospital Facility.
• Responsible for supervision of any Dispensaries within Health Zone OR provide oversight for Aid Post facilities where there is no established Dispensaries within the Health Zone.
• May be varied (ie for smaller population or less activity) if travel time to nearest EHC or provincial hospital is more than four (4) hours or area is often isolated 4b Enhanced Health Centre EHC As for a Health Centre for all details, except: • Catchment population may be larger • May have other Health Centres within the same Health Zone • May have extended time to travel to access the next higher level facility 24 3 Provincial Hospital PH Each province is to have a Provincial Hospital (PH) established within the Provincial boundaries.
Planning Baseline: • Catchment Population = Provincial population • Responsible for referral from all Health Centres and Enhanced Health Centres within Province • All referral cases can access the facility from a Health Centre or Enhanced Health Centre, within 4 hours (by the most common mode of access eg walking, paddling, truck, boat etc) under non- emergency situation.
• Priority (emergency) referral cases can reach the hospital within one (1) hour from Provincial Hospital utilising most expedient form of transport • Has access to airfield within 30 mins land transport from hospital location for fixed wing and rotary wing aircraft 2 Regional Referral Hospital RRH A Regional Referral Hospital (RRH) is located centrally to multiple provinces.
Planning Baseline: • Catchment Population = Up to 4 Provincial population(s) • Responsible for referral from up to four (4) provincial hospitals • All referral cases can access the facility from Provincial Hospital, within 4 hours (by the most common mode of access eg walking, paddling, truck, boat etc) in non-emergency • Priority (emergency) referral cases can reach the hospital within one (1) hour from Provincial Hospital utilising most expedient form of transport • Has access to airfield within 30 mins land transport from hospital location for fixed wing and 25 1 National Referral Hospital NRH National Referral Hospital is located close to the main transport hub of Vanuatu for domestic and international flights.
rotary wing aircraft Planning Baseline: • Catchment Population = Vanuatu population • Responsible for referral from all Regional Referral Hospitals within the country and for provision of other specialised allied health and clinical services • All referral cases can access the facility from a Regional Referral Hospital, within 4 hours (by the most common mode of access eg walking, paddling, truck, boat, air etc) under non-emergency situation.
• Priority (emergency) referral cases can reach the hospital within one (1) hour from Regional Referral Hospital utilising most expedient form of transport.

• Has access to airfield within 30 mins land transport from hospital location for fixed wing and rotary wing aircraft.
Has ability for emergency rotary wing landing within Hospital grounds 26 APPENDIX B: HEALTH CARE SERVICES 27 PRIMARY CARE FACILITIES Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) Basic care - Conduct minor As for Aid Posts plus: As for Dispensaries plus: As for Dispensaries plus: As for Health Centres plus: APPENDIX B1: PRIMARY HEALTH CARE SERVICES - - Inpatient care for maternity care services Stabilisation and quick referral of life-threatening cases such as emergency obstetric conditions examinations of common diseases, referring clients with signs and symptoms indicative of more serious or complex conditions to a Dispensary or Health Centre (or a Hospital – in emergency situations only).
- Clean and dress wounds.

Treat sores, and other - common conditions.

- Provide basic counselling to clients (as required and training allows).
- Administer CPR - IV antibiotic treatment and fluid replacement - Outpatient clinical services to treat common illnesses and injuries - Observation, stabilization and referral of cases to a Health Centre or directly to a hospital - Minimal in-patient care for cases that need observation in first 24-48 hours of treatment before sending home or awaiting transfer to higher level of care - Minor operative procedures – including primary suturing, incision of abscess, removal of foreign bodies, splints.
- Triaging, assessment, diagnosis, basic treatment, referral and follow-up of patients presenting with medical conditions.

- Transfer of patients requiring urgent care to Hospital ED or Emergency Medicine specialist.

- Short term holding of patients requiring asthma treatment (nebuliser) - Reporting of communicable diseases and initiation of follow-up.
- - - Inpatient care for medical, surgical, paediatric and maternity care services Specialized care through outreach/mobile specialists – including eye specialists, Ear, Nose and Throat (ENT), dentists, and obstetric & gynaecological care Stabilisation and quick referral of life-threatening cases such as emergency obstetric conditions, trauma, fracture, head injuries, heart attack, bleeding, acute abdominal pain - Minor operative procedures, including primary suturing, incision of abscess, removal of foreign bodies, splints.
28 Health Domain Health promotion Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) As for Aid Posts As for Dispensaries As for Remote Dispensaries plus: As for Health Centres - Work with and support Village Health Workers to provide health promotion/education services to community and to develop community health development plans.
- Support Dispensaries in reinforcing healthy behaviors – school visits/ one to one health education - Promotion of healthy behaviours through distribution of Information, Education and Communication (IEC) materials, school and village health talks and inspections and assisting implementation of healthy settings (schools, villages) through Healthy Islands policy.
Identification of community development needs for health through community mapping Establishment of community health development plans to address needs, including ‘development for health improvement’ project ideas for further assessment by Area Nurse.

- - - Monitor community health, trends and emerging diseases.
- Provide risk communications for disaster response 29 Health Domain Communicable diseases Environmental Health Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) - Information, Education and Communication (IEC) on early identification and referral to a Dispensary or Health Centre for treatment of endemic diseases (e.g, malaria, diarrhoea, others) - Mobilise community - members for routine nurse- administered health services such as vaccinations.
Support the work of visiting public health staff and teams, eg the Malaria team in routine distribution of malaria insecticide treated bed nets.

- Education and support to community based activities which seek to break the faecal-oral transmission of disease, which cause acute diarrhoea, infestation of gut and other parasites and which contribute to stunting in children.

- Health facility safe waste disposal and management.
- Outreach environmental activities including As for Aid Posts plus: As for Dispensaries As for Dispensaries, plus: As for Health Centres - Diagnosis and treatment of malaria and TB, or referral to Health Centre.

- Enhanced level of treatment of malaria and TB.
- Enhanced level of diagnosis and treatment of all communicable diseases (within scope of practice) - Onwards referral of CD patients to hospital level As for Aid Posts plus: As for Dispensaries As for Dispensaries As for Health Centres - Education and support to community based activities which seek to break the faecal-oral transmission of disease, which cause acute diarrhea, infestation of gut and other parasites and which contribute to stunting in children.
- Health facility safe waste disposal and management 30 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) organization of village clean ups and maintenance.

- Outreach environmental activities – support village clean ups and maintenance through Aid Posts.
STI/HIV - Information, Education and Communication (IEC) on prevention of STI/HIV infections to promote behavioural change and to promote advocacy on STI/HIV by community leaders.

- Access to free condoms Reproductive health (Including sexual Violence) - Information, Education and Communication (IEC) on family planning.

- Provision of condoms and referral to Dispensary for other contraceptives, for eg.

IUD insertion, Jadelle insertion Ante natal care - Early identification of pregnancy in community.
As for Aid Posts plus: As for Dispensaries As for Dispensaries As for Health Centres - Treatment of STI’s and detection of HIV - Post – exposure prophylaxis (PEP) for STI and HIV infections As for Aid Post plus: As for Dispensaries As for Dispensaries As for Health Centres: - Provision of contraceptives, IUD insertion and Jadelle insertion Emergency contraception - - Conduct of assessment using Sexual Assault Kits (SAK) and interaction with authorities for administration of positive confirmations.
As for Aid Post plus: As for Dispensaries plus: As for Remote Dispensaries As for Health Centres - Advice, early referral to Dispensary or Health Centre and follow-up, including nutritional - Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advice on - Manage risk pregnancy 31 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) information and support.
nutrition & breastfeeding, self-care and family planning, preventive treatment as appropriate.

Supplementation of iron folic acid - Intra-partum Care - N/A As for Aid Post plus: As for Dispensaries As for Health Centre As for Health Centres - - Skilled care during childbirth for clean and safe normal delivery Some higher risk deliveries in remote areas where a mid-wife is assigned.
- Basic emergency obstetric care (BEOC): parenteral antibiotics + oxytocic/anticonvulsant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 - Management of post- partum hemorrhage, undiagnosed twins or breech delivery, and referral for post abortion care.
Post partum -Information and counselling on As for Aid Post plus: As for Dispensaries plus As for Remote Dispensaries As for Health Centres 32 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) - Immediate and emergency care for newborn babies self-care (nutrition and safe sex, good rest, less work), family planning, birth spacing, exclusive breastfeeding, recognition of danger signs including blues and depression, domestic sexual violence, use of malaria (ITN) nets To provide home visit to provide above services for both newborn and mothers - Postpartum care: Home visit integrated with newborn, outreach and facility visit: - examination of mother and newborn (up to 6 weeks), respond to observed signs, referral of complications, support breast feeding, promote family planning Newborn Care Promotion and support for : As for Aid Posts: As for Dispensaries As for Remote Dispensaries As for Health Centres - Home visit integrated with - mothers, Essential newborn care: basic newborn resuscitation + warmth (recommended method: Kangaroo Mother Care) + eye prophylaxis + clean cord care + early and exclusive breast feeding 24/24 & 7/7 Exclusive breastfeeding, thermal care, infection prevention by hand washing, general hygiene, safe disposal of baby’s faeces.
Recognition of Newborn danger signs and problems and timely care seeking Care for small babies, breastfeeding, skin to skin contact Prevention of indoor air pollution Birth registration 33 Health Domain Child health (0- 5) Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) - Continue support with feeding, promoting exclusive breast feeding for at least 6 months.
- Promotion of immunisations, including: community awareness of vaccine-preventable diseases (in accordance with national immunisation schedule); and community mapping for identification and mobilisation of eligible children ahead of immunisation visits.
- Conduct minor examinations of common child hood illnesses including: respiratory infection (pneumonia), fever and infection, gastroenteritis including diarrhoea, malnutrition and anaemia referring those with signs and symptoms indicative of more serious or complex conditions to a Dispensary or Health Centre (or a Hospital – in emergency situations only).
- Ongoing child growth monitoring and referral to higher levels as As for Aid Posts, plus: As for Dispensaries: As for Remote Dispensaries As for Health Centres - Infant and Young Child Feeding (IYCF) (breastfeeding & complementary feeding) counselling including promotion of breast feeding for 6 months.

- Routine immunization through the Enhanced Program of Immunization (EPI) against all national target diseases - functioning cold chain in place.
Integrated management of childhood illness (IMCI) to identify common child hood illnesses including: respiratory infection (pneumonia), fever and infection, gastroenteritis including diarrhea, malnutrition and anemia, integrated with distribution of insecticide-treated bednets - - Management and referral for treatment of endemic childhood illnesses if medical complications.
34 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) Child and adolescent health (5 – 17) - appropriate.

Screening for early detection of acute malnutrition - Middle upper arm circumference (MUAC) and oedema - referring those with moderate and severe acute malnutrition (SAM) with medical complications.
- All of the above, with the exception of services relevant to children under 5, for example infant and young child feeding.

- Promotion of healthy behaviours through Information, Education and Communication (IEC) to prevent injury; increase road safety; and increase sexual and reproductive health.

Food and nutrition - Basic nutrition guidance to individuals, particularly those at risk of undernutrition, and community.
At risk groups include: iron deficiency in As for Aid Posts As for Dispensaries As for Remote Dispensaries As for Health Centres As for Aid Posts As for Dispensaries As for Remote Dispensaries As for Health Centres 35 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) Non Communicable Disease pregnant and breastfeeding women; early and exclusive breastfeeding (up to 6 months); transition of breastfeeding to complimentary feeding.
Support community planning and activities which promote optimal nutrition, especially for pregnant women, infants and children.

- - Provide basic care and As for Aid Posts plus: As for Dispensaries As for Dispensaries plus: As for Health Centres, plus: - support, and promote self- care for people affected by NCD and chronic conditions.
Identify and refer severe cases for treatment, provide needed follow up to people with chronic health conditions and disabilities and discharged by facility based health services.

(NCD may include, diabetes, cardiovascular disease, mental health, oral health, eye health, drugs and substance abuse, violence and road injuries).

- Provide outpatient clinic for people with mental health illness.
- Administration of anti- psychotics for at risk patients - - Surveillance of risk factors and signs/symptoms, through basic NCD screening to include: blood pressure; height; weight; waist; BMI; and counselling.

Injury care and mass casualty management Treat and manage NCD’s, including diabetes and hypertension in accordance with Package Essential Interventions (PEN) - Provide basic care for - mental health.
36 Health Domain Aid Post (Level 6) Dispensary (Level 5a) Remote Dispensary (Level 5b) Health Centre (Level 4a) Enhanced Health Centre (Level 4b) As for Aid Posts, including: As for Dispensaries As for Remote Dispensaries As for Health Centres - Working knowledge of approved essential medicines for Dispensaries, and a working on knowledge of how to administer each item Provision of essential medicines - Working knowledge of approved essential medicines list for Aid Posts, and a working knowledge of how to administer each item (including a knowledge of ‘’from where to source guidance’’).
Storage, stock take, drugs order - - Aseptic technique for equipment and disposable medication, sharps and rubbish 37 Aid Post Area Referral APPENDIX B2: PRIMARY CARE FACILITY CORE REQUIREMENTS Core requirements to support service delivery Village Health Workers are trained to understand the limitations of their skills and experience and the boundaries of their scope of practice.

They are required to assess clients, and recognize when their signs and symptoms are beyond their capacity of training?.
Village Health Workers are required to refer clients with more complex conditions to a Dispensary or Health Centre (or a Hospital – in emergency situations only) Sometimes the Village Health Worker will be required to personally escort the client to the health care facility.

However in most cases, the Village Health Worker will prepare a referral letter for the client or family member to take to the next health facility to present to the nurse.
The nurse should always provide written feed back to the Village Health Worker on the true diagnosis and treatment, and if more follow up is required.

Facility management and administration It is the responsibility of both the Aid Post Committee and the Village Health Worker to engage with the community for participative maintenance of the Aid Post building and surrounding grounds.
In addition to this, the Village Health Worker has a responsibility to maintain the cleanliness and orderliness of the Aid Post on a day-to-day basis.

A brief summary of the functions detailed in the VHW Scope of Practice is provided below.

- Be familiar with the MOH Village Health Worker Scope of Practice and the Village Worker Health Worker Program Aid Post Manual.

- Manage Information / data collection activities relating to Health Information Systems (HIS) activities.
- Maintain a daily logbook of client / patient contacts.

- Under the direction of the Aid Post Committee record and manage funds collected for patient treatment or through community fund raising in support of the Aid Post.

- Manage drug orders - Provide secretarial support to the Aid Post Committee.
38 Dispensary Area Referral Facility management and administration Supervision Core requirements to support service delivery - Required to refer clients with more complex conditions to a Health Centre (or a Hospital – in emergency situations only).

- In most cases, will prepare a referral letter for the client or family member to take to the next health facility to present to the nurse and will arrange an escort as needed.
- Be familiar with MOH policies, procedures and processes and public service staff guidelines.

- Manage the resources of the facility, establishing and maintaining an inventory of all equipment, furniture and supplies.

- Monitor use of medicines and other supplies and initiate re-ordering.

- Maintain clinic standards for hygiene, water and sanitation.
- Submit consolidated monthly reports of services provided and activities conducted; tally and analyse monthly data on health services provided, for example, review of consultations (“health information” includes the Monthly Malaria Line List report and the Enhanced Program for Immunisation statistics)18, Supervise the nurse aid to keep records, monitor and report on the use of clinic fees to Health Committee.

- - Conduct regular meetings with Health Committee to discuss community support for dispensary.
- - - - Visits Aid Post Village Health Worker at least every 6 months to provide supervision and provides on call support.

- Submit quarterly reports to Supervisor (zone nurse or provincial health manger), and ask for feedback and discussion on reports.

Ensure community is informed of Dispensaries operating hours and services.

Supervises Nurse Aid Should receive at least two supervisory visits from provincial health manager per year.
- 18 Currently, quite a few public health programs collect their data separately including Neglected Tropical Diseases, and TB.

These health data collection activities will be potentially be integrated in 2018.

39 Remote Dispensary Area Referral Facility management and administration Supervision Core requirements to support service delivery - Required to refer clients with more complex conditions to a Health Centre (or a Hospital – in emergency situations only).
- In most cases, will prepare a referral letter for the client or family member to take to the next health facility to present to the nurse and will arrange an escort as needed.

- Be familiar with MOH policies, procedures and processes and public service staff guidelines.

- Manage the resources of the facility, establishing and maintaining an inventory of all equipment, furniture and supplies.

- Monitor use of medicines and other supplies and initiate re-ordering.
- Maintain clinic standards for hygiene, water and sanitation.

- Submit consolidated monthly reports of services provided and activities conducted; tally and analyse monthly data on health services provided, for example, review of consultations (“health information” includes the Monthly Malaria Line List report and the Enhanced Program for Immunisation statistics)19, Supervise the nurse aid to keep records, monitor and report on the use of clinic fees to Health Committee.
- - Conduct regular meetings with Health Committee to discuss community support for dispensary.

- - - - Visits Aid Post Village Health Worker at least every 6 months to provide supervision and provides on call support.

- Submit quarterly reports to Supervisor (zone nurse or provincial health manger), and ask for feedback and discussion on reports.

Ensure community is informed of Dispensaries operating hours and services.
Supervises Nurse Aid Should receive at least two supervisory visits from provincial health manager per year.

40 Health Centre Area Referral Facility management and administration Supervision Core requirements to support service delivery - Required to refer clients with more complex conditions to a Hospital – in emergency situations only.
- Clinical staff are expected to provide written feed back to the Registered Nurse or Midwife at the Dispensary / Remote Dispensary on the true diagnosis and treatment, and advise if more follow up is required.

- Be familiar with MOH policies, procedures and processes and public service staff guidelines.

- Manage the resources of the facility, establishing and maintaining an inventory of all equipment, furniture and supplies.

- Monitor use of medicines and other supplies and initiate re-ordering.
- - Conduct regular meetings with staff to discuss HC operations, review HC data and consultations.

- Ensure clinic standards for hygiene, water and sanitation are maintained.

Submit consolidated monthly reports of services provided and activities conducted; tally and analyse monthly data on health services provided, for example, number of consultations.

- Compile an annual report of the HC and submit to provincial health manager.
- Attend meetings representing staff of HC and provide feedback upon return.

- - Manage and supervise staff, including all human resource functions, such as monitoring leave and other absences and conducting Liaise with Provincial Health Manager on staffing, finances, supplies and other matters.

annual staff performance appraisals.

Supervises HC nursing staff Supervises dispensary staff within the HC zone, which are responsible to the HC OR VHWs where there are no dispensaries within the health zone.
Should receive at least two supervisory visits from the Provincial Health Manager per year - - - 41 Enhanced Health Centre Area Referral Facility management and administration Supervision Core requirements to support service delivery - Required to refer clients with more complex conditions to a Hospital – in emergency situations only.
- Clinical staff are expected to provide written feed back to the Registered Nurse or Midwife at the Dispensary / Remote Dispensary on the true diagnosis and treatment, and advise if more follow up is required.

- Be familiar with MOH policies, procedures and processes and public service staff guidelines.

- Manage the resources of the facility, establishing and maintaining an inventory of all equipment, furniture and supplies.

- Monitor use of medicines and other supplies and initiate re-ordering.
- - Conduct regular meetings with staff to discuss HC operations, review HC data and consultations.

- Ensure clinic standards for hygiene, water and sanitation are maintained.

Submit consolidated monthly reports of services provided and activities conducted; tally and analyse monthly data on health services provided, for example, number of consultations.

- Compile an annual report of the HC and submit to provincial health manager.
- Attend meetings representing staff of HC and provide feedback upon return.

- - Manage and supervise staff, including all human resource functions, such as monitoring leave and other absences and conducting Liaise with Provincial Health Manager on staffing, finances, supplies and other matters.

annual staff performance appraisals.


Supervises HC nursing staff Provides education and training opportunities where possible Supervises dispensary staff within the HC zone, which are responsible to the HC OR VHWs where there are no dispensaries within the health zone.
Should receive at least two supervisory visits from the Provincial Health Manager / Visiting Clinical Teams per year - - - - 42 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided APPENDIX B3: SECONDARY / TERTIARY HEALTH CARE SERVICES EMERGENCY & CRITICAL CARE Emergency medicine & trauma care       Resuscitation & stabilisation of patients with life threatening conditions prior to transfer to higher level care.
ED trained Medical officer available 24/7 (on call after hours) Triaging, assessment, diagnosis, basic treatment and referral of patients presenting with injury/trauma or acute illness.
Short-term admission of patients with acute conditions requiring observation/treatment or awaiting transfer Access to mobile X-ray Dispensing of emergency medications after hours     Resuscitation & stabilisation of patients with life threatening conditions, including defibrillation, intubation and short-term ventilation.

Transfer to NRH if required.


Triaging, assessment, diagnosis and treatment of patients presenting with injury/trauma or acute medical conditions or referred from other health facilities.

Paediatric emergency service supported by paediatric team on call.

24/7 cover by medical officer and specialist ED nurses.

Emergency Medicine consultant on call after hours on site or within 60 minutes.
 Mobile X-ray and ABG analysis available  Short-term admission of seriously ill patients requiring monitoring/observation/treatment or awaiting transfer.

As for Regional Referral Hospital PLUS       Able to manage full range of emergencies including major trauma and cardiac emergencies.

Provide cardiac monitoring and short-term ventilation of critically ill patients awaiting transfer to intensive care (ICU, PICU, NICU).
Separate adult and paediatric emergency treatment areas Some laboratory tests available within department.

24/7 cover by Emergency Medicine consultant and registrars plus specialist emergency nurse, with on call access to consultant/SMO in other specialties.

Provides consultant advice to other hospital emergency departments.
Retrieval & emergency transfers • Organisation of ambulance transfers to As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS referral hospital from lower level facilities.

Ambulance service staffed by drivers with paramedical training.

Provision of nurse escort if required.

Access to air ambulance service.

• • • • • • Coordination of emergency retrievals and transfers of critically ill patients from other hospitals.

Coordination of emergency ambulance/air transfers to NRH.
Provision of medical/nursing escort if • • Provision of medical retrieval team to transfer critical patients from accident sites and other health facilities.

Coordination of emergency transfers to overseas hospitals 43 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Disaster response High dependency/Intensive care • • • •    Local disaster plan in place.
Designated disaster response officer with training in coordinated disaster response.

Coordination of disaster response at provincial health facilities.

Provision of self-sufficient, off-grid Emergency Operations Centre (EOC) in times of disaster.

General ward includes 1-2 beds equipped for close observation/monitoring of acutely ill or post-operative patients.

Ideally, these beds are in a separate room for better infection control.

ICU specialist from NRH available on call 24/7 for consultations.
Strictest infection control system applies.

required.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS • • • • Coordination of disaster response at regional health facilities.

Standby power & water available and regularly tested Separate high dependency unit (HDU) providing close observation, monitoring, oxygen and short term [<24 hours] ventilation, with patients requiring higher level care or prolonged ventilation transferred to NRH.
Specialist high dependency nurses (1:4 bed) plus medical supervision by consultant physicians, surgeons and anaesthetists, with consultancy support from ICU specialists at the NRH.

• Medical, surgical, maternity and paediatric wards include two HDU/step down beds equipped for close observation/monitoring of acutely ill or post-operative patients.

Strictest infection control system applies.

•    Coordination of national health disaster response and mobilisation of Emergency Medical Teams (EMT).
Supervised by National Disaster Coordinator Able to establish mobile hospital/clinic during disaster.

 Intensive care unit (ICU) capable of providing complex life support including medium term mechanical ventilation, provides specialist referral service for critically ill patients from all provinces.

 Medical supervision by designated SMO anaesthetist/intensivist, on call 24/7.

Designated ICU MO available on site 24/7.

 Nursing staff have specialist intensive care training.
 Unit incorporates intensive care and      HDU/stepdown beds, with bedside and central monitoring available.

Paediatric patients managed in PICU Standard protocols and procedures in place.

Strictest infection control system applies.

24/7 availability of diagnostic, pharmacy and operating theatre services.

ABG on site.

Has formal links (training, consultation, clinical standards) with an intensive care service in a tertiary referral hospital overseas.
44 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided MEDICAL General outpatient clinic services Specialist outpatient services           Triaging, assessment, diagnosis, basic treatment, referral and follow-up of patients presenting with medical conditions, provided by general medical officers/nurse practitioners and RNs.
Referral of patients to NCD and other specialist clinics.

Transfer of patients requiring urgent care to ED or Emergency Medicine specialist.

Provision of wound care, dressings and injections Short term holding of patients requiring observation, rehydration, IV antibiotics or asthma treatment (nebuliser) Referral of patients requiring admission to inpatient services to responsible MO.

Reporting of communicable diseases and initiation of follow up.

Health education for individuals and groups.


Assessment, diagnosis, treatment, ongoing management and referral of patients referred from GOPD or other health facilities.

Specialist clinics [e.g Medical, STI/HIV, TB] provided by general medical officers, and/or specialist and allied health staff.

 NCD hub providing multi-disciplinary care for patients referred from GOPD and other  Provides daily consultant supervision to RRH.
As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Triaging, assessment, diagnosis, basic treatment and referral of patients referred from other health facilities.

After hours emergency service provided via ED.

 Medical consultation and specialist referral provided to patients referred from other health facilities or private practitioners.
As for Provincial Hospital PLUS As for Regional Referral Hospital  Specialist Internal Medicine clinics provided by consultant physicians, medical officers and specialist nurses.

45 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided health facilities, staffed by medical officers, specialist nurses, dietitians, eye nurses and foot care nurses.
Provision of reports to referring health workers for patient follow-up.

 Sub-specialist clinics  May have visiting services provided by  outreach teams Some more specialised outpatient services (eg cardiac, oncology, renal) may be provided by outreach teams from NRH or visiting overseas teams.
 Outpatient clinic services provided by visiting or local consultant physicians with specialist qualifications in areas such as Cardiology, Endocrinology, Oncology, Respiratory Medicine Neurology and Infectious Diseases.

Inpatient care  Admission of patients with medical conditions referred from outpatient clinics or other health facilities.

 Medical inpatient care provided in separate male and female wards, staffed by nurses, nurse aides and supervised by a medical officer.
Isolation of patients with infectious diseases.

Discharge of patients for follow up/continuing care by referring health facility/practitioner.

  As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS        Admission of patients with more complex medical conditions referred from outpatient clinics or other health facilities.

Provision of higher dependency care, including cardiac monitoring, for more seriously ill patients.
Short term admission of patients for procedures such as blood transfusion, pleural taps and IV antibiotics.

Inpatient care provided in medical ward, staffed by specialist clinical nurses, RNs, nurse aides and supervised by a consultant physician.

Isolation of patients with infectious disease: separate area for TB patients.

Stable psychiatric patients may be admitted.

Physiotherapy support available for respiratory and stroke patients.
     Provides nation-wide referral service for patients with complex or rare medical conditions that cannot be managed in other facilities.

Has access to international clinical consultation and may transfer selected patients for treatment overseas.

Provision for coronary care patients in a designated area with cardiac monitoring.

Chemotherapy provided mainly on a short stay or day only admission basis.

Has designated area with protective isolation for oncology and immuno- compromised patients.
Some nurses have specialised training in areas including cardiology/coronary care, oncology, diabetes and renal medicine.

46 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Cancer Services       Cancer prevention programs (e.g smoking cessation, healthy lifestyle, Hepatitis immunisation) conducted in conjunction with public health services.
Reporting new cancer cases and deaths to National Cancer Registry Promotion of breast self-examination Screening and early diagnosis of common cancers Treatment of cervical cancer with VIA, cryotherapy, LETZ/LEEP.

Palliative care for terminal cases [Refer below].

SURGICAL Surgical clinics  Outpatient consultation, assessment,  diagnosis and referral of patients referred from GOPD and other health facilities.
Clinics conducted by visiting surgical team from referral hospital Access to specialist surgical services at referral hospitals.

  Specialist surgical clinics As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS    Diagnostic procedures eg biopsy Surgical removal of selected tumours Pain management service provided by internal medicine, pharmacy and anaesthetic staff.
  Administration of chemotherapy to adult and paediatric patients by specialist trained chemotherapy nurses, supervised by Oncology SMO Strict infection control/protective isolation for immuno-compromised patients  Oncology pharmacy available on site  Formal professional and referral links with major cancer centre overseas to support staff training and cancer service delivery/development.

 Maintenance of National Cancer Registry: monitoring of cancer incidence/prevalence.
General Surgical Clinics conducted by consultant surgeons and registrars, with specialist surgical nurses providing consultation, assessment, diagnosis and management of patients referred from GOPD and provincial hospitals.

As for Regional Referral Hospital PLUS  Specialist wound management service provided in clinics and on a consultancy basis to staff in other health facilities.
 More specialised outpatient clinic services may be provided by visiting surgical teams eg orthopaedics, plastics, urology, ENT, paediatric.

 Outpatient clinic services provided by local specialist surgeons and visiting specialist surgical teams with sub-specialist training.

Specialties include orthopaedics/fracture, urology, ENT, ophthalmology, plastics and paediatric surgery.
 Surgical procedures  Minor surgical procedures on low risk As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS patients, plus a limited range of emergency  Elective and emergency surgical procedures  Elective and emergency surgical procedures 47 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Inpatient care Eye/Ophthalmology services procedures, performed by resident doctors with surgical skills, mostly on a ‘day only’/outpatient basis.
Debriding of septic wounds [may be done in theatre or ‘dirty’ procedure room].

  More complex/specialised surgery performed by visiting surgical teams.

         Admission of patients with surgical conditions referred from outpatient clinics or other health facilities.

Inpatient and post-operative care for surgical patients provided in separate male and female wards, staffed by nurses, nurse aides and supervised by a MO.
Discharge of patients for follow up/continuing care by referring health facility/practitioner Referral to RRH/NRH if required for more complex cases and for specialist care.

Eye clinic conducted by specialist Eye Nurse.

Identification and treatment of simple eye infections and injuries; removal of foreign bodies; referral as appropriate.
Visual acuity and general eye health testing; prescription and supply of glasses Diabetic retinopathy screening and referral for laser treatment School screening provided on outreach basis (major and minor) on low-moderate risk patients (ASA 1-3) performed by consultant surgeons and registrars.

(major and minor) on patients in high risk (ASA category 4) performed by consultant surgeons and registrars.
 More specialised surgery performed by local and visiting surgeons with sub-specialist training include orthopaedics/fracture, urology, ENT, ophthalmology, plastics and paediatric surgery.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Admission of surgical patients referred from provincial hospitals.

Inpatient care for patients provided in surgical wards, staffed by surgically trained nurses, nurse aides and supervised by the surgical team.
Provision for higher dependency care, including monitoring, for more seriously ill patients.

    Admission of patients referred with surgical conditions requiring sub-specialist management or higher dependency care, including monitoring.

Inpatient areas providing for separation of patients with sepsis/infections from other post-operative patients and separate area for burns patients.

Access to rehabilitation service and prosthetics consultation on site.
Some nurses have specialised training in areas such as urology, ENT, orthopaedics, burns and amputee care.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS    Specialist Ophthalmology clinic conducted by specialist Eye Nurse and Ophthalmologist.

Identification and treatment of more serious eye infections and injuries; refer as appropriate.
Diabetic retinopathy screening & laser treatment   Service provided by specialist Eye Nurses and specialist Ophthalmologist Coordination and clinical supervision of clinical ophthalmology services nationally.

 Manages complex eye surgery, major eye trauma and ophthalmic emergencies in patients referred from all provinces.
 Provision of mobile outreach team to other 48 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided   Referral to Ophthalmologist for treatment of cataracts and other conditions requiring specialist management.

Primary eye care education/promotion   Eye surgery including cataract removal and other procedures, mostly performed on a day only basis.
Referral to NRH for more complex procedures like retinal surgery.

  Consultant on call for major eye trauma and ophthalmic emergencies  Ongoing management of complex/chronic ophthalmic conditions.

health facilities Coordination of visiting overseas eye teams Has links with Pacific Eye Institute for training, clinical standards and service development.
ENT services  Outpatient clinic conducted by specialist ENT As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Nurse Identification and treatment of simple infections of ear, nose or throat; manage foreign bodies; referral as appropriate.

Basic audiology and speech testing; referral for hearing aids assessment.
School screening provided on outreach basis   May have visiting hearing aid service  Referral to ENT Surgeon for patients requiring further assessment/ specialist management.

 Outpatient clinics conducted by visiting ENT    surgeon or ENT registrar.

Identification and treatment of more serious infections of ear, nose or throat; referral if necessary.

Audiology, speech and tympanometry testing; assessment for hearing aids by audiologist or nurse audiometrist.
Referral to NRH for patients requiring surgery and specialist management    Outpatient clinic conducted by specialist ENT consultant surgeon/registrar.

Audiologist and speech pathologist available on site.

Coordination of National Hearing Care service.

ENT surgery for both elective and emergency cases by ENT surgeon with trained ENT theatre nurse.

Training of specialist ENT nurses.


  Oral Health/Dental  General dental service including oral health promotion, pain relief, fillings, extractions, management of simple trauma by local or visiting dentist/dental therapist.

 Outreach to communities and health facilities with public health teams  Referral to RRH and NRH for maxillo-facial surgery As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Complex restorative dentistry; dental prosthetics.
 Oral/maxillo-facial surgery - management of dental trauma, fixation of facial fractures and low-moderate risk elective procedures.

Some specialist dental services including periodontics, endodontics and prosthodontics, provided by visiting specialist dentists.
   Provides oral/maxillo-facial surgery service for patients with major trauma and complex dental conditions referred from other hospitals Provides specialist dental services including periodontics, endodontics, paediatric dentistry and specialised prosthodontics.

49 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided  Oral surgeon on call for emergency cases.
As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Cleaning and treatment of minor-moderate burns.

Initial resuscitation, stabilisation and prompt transfer of serious/extensive burns to national referral hospital.

  Surgical management of patients with severe/extensive burns, including resuscitation, debriding, acute care, rehabilitation and management of contractures.

Separate inpatient burns unit with protective isolation and nursing staff trained in burns care.
As for Provincial Hospital PLUS As for Regional Referral Hospital     High risk antenatal clinics conducted by obstetricians & midwives for pregnant women referred from provincial hospitals and outpatient clinics.

Gynaecology clinics, providing specialist consultation for patients referred with gynaecological issues.

Colposcopy and cryotherapy services Antenatal screening/diagnosis with chorionic villus sampling (CVS) or amniocentesis.
   Antenatal care and management of women with high risk pregnancies referred at 32-34 weeks from other provinces.

Antenatal day assessment of women with high risk pregnancies requiring close monitoring.

Infertility clinic Burns   Cleaning and treatment of minor burns.

Initial resuscitation, stabilisation and prompt transfer of serious burns to NRH.
MATERNAL AND REPRODUCTIVE HEALTH Outpatient services     Antenatal clinics conducted by midwives and MO, providing o Early assessment and continuing o management of pregnancy, in line with MoH Standard Guidelines for Obstetrics, Gynaecology and Newborn Care.

Identification & referral of patients with high risk pregnancies to high risk clinics, with transfer to referral hospital at 32- 34 weeks.
Postnatal clinics (7 days & 6 weeks post- partum) Family planning/women’s health clinics, providing contraceptive advice and supplies, pap smears, VIA, PMCT testing and counselling and general gynaecological health checks.

Insertion of loops and Jadelle implants by trained midwife or MO.
Referral to specialist service of patients 50 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided requiring gynaecological surgery or more complex treatment.

Specialist clinics provided by visiting O&G teams.


 Delivery and intrapartum care  Management of normal vaginal deliveries, As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS early essential newborn care and provision of emergency obstetric care in line with National Obstetric and Gynaecology Guidelines.

Vacuum extractions and manual removal of placenta by midwives or MOs.

    Neonatal resuscitation if required performed by specially trained midwives or medical officers.
Provision of IV antibiotics if required for puerperal sepsis and PID.

Timely antenatal transfer of women with high risk pregnancies/requiring caesarean section to referral hospital.

Emergency caesarean section (+/- TL) may be performed by resident medical officer with obstetric training or mobile emergency obstetric team from referral hospital.

 Inpatient care    Admission of patients for antenatal assessment/care, postnatal care and breastfeeding support.
Inpatient care provided in maternity ward, staffed by midwives, nurses, nurse aides with medical officer support.
Discharge of patients for early post-natal care by home visiting team and continuing care by    Comprehensive obstetric emergency care as per Standard Guidelines for Obstetrics, Gynaecology and Newborn Care Elective and emergency caesarean sections, performed by obstetricians or obstetric registrars, attended by paediatricians or midwives trained in neonatal resuscitation, on patients referred from other hospitals or health centres.
Immediate transfer to special care nursery (SCN) of premature, very small or sick babies.

 Obstetric management/delivery of women with serious medical conditions or whose babies are expected to require neonatal intensive care.

 Mobile Obstetric team (‘Flying Squad’) provided for emergency deliveries where patient cannot be transferred safely to NRH.

 Maternity Intensive Care (MICU) service   linked with birthing area.
Has 24/7 on site access to medical laboratory, blood bank, medical imaging, pharmacy, ICU and NICU.

Formal review of all Maternal and Perinatal deaths in Vanuatu hospitals As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Antenatal admission of patients with high risk pregnancy/medical conditions referred from outpatient clinics or other health facilities.

 Maternity HDU for sick pregnant or postnatal women, including immediate post-caesarean cases.
Admission of gynaecological surgery patients   MICU for postnatal care of sick women, including immediate post-caesarean cases.

51 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided local midwife/health facility.
Gynaecological surgery  Minor gynaecological procedures (D&C, tubal Sexual Health ligation, vasectomy, LETZ/LEEP etc) performed by resident medical officer with procedural skills.

 Other gynaecological surgery performed by visiting O&G team.

   Comprehensive management of STI and HIV.

Identification, counselling, support and referral of victims of gender-based violence, rape & sexual assault.
Provision of emergency contraception and post – exposure prophylaxis for STI and HIV infections for sexual violence victims.

 On call service to ED available 24/7 for post-operative care in women’s surgical ward.

 Minor and major gynaecological procedures performed by O&G consultants or registrars.

Access to oncology services at NRH for patients with gynaecological cancers.
    Full range of gynaecological procedures, including on high risk (ASA 4) patients and gynaecological cancers, performed by O&G consultants or visiting teams.

Laparoscopic procedures Access to oncology and palliative care services for gynaecological cancer patients.
As for Provincial Hospital As for Regional Referral Hospital NEWBORN, CHILD & ADOLESCENT SERVICES Newborn care   Provide Early Essential Newborn Care (EENC) for all neonates: Provide Kangaroo mother care and refer for special care if sick or premature.

 Neonatal resuscitation performed if required by specially trained midwives or medical officers.

Promotion of early breastfeeding.


 As for Provincial Hospital PLUS As for Regional Referral Hospital  Delivery and care of very premature or low birth weight babies, referred antenatally from other health facilities.

 Neonatal resuscitation performed if required by paediatricians or specially trained midwives.
52 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Special care nursery/NICU   Provision of Kangaroo mother care and higher dependency care for late preterm and sick neonates in separate special care nursery area: transfer to national referral hospital if longer term care, surgery or assisted ventilation is required.

Phototherapy for babies with uncomplicated jaundice.
Child Health/Paediatric clinics   IMCI clinics provided by trained paediatric nurse and MO for assessment, diagnosis, treatment and referral of sick children.

Specialist referral clinics provided by visiting paediatric team.

Immunisation/MCH clinics provided in conjunction with Public Health.

 Nurses trained in child protection.


 As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS      Provision of high dependency care, including apnoea monitoring, nasogastric feeding, short term IV therapy and short-term respiratory support (CPAP) for small, late preterm and sick neonates in a separate special care nursery (SCN).

Transfer to national referral hospital if longer term assisted ventilation, higher level care or surgery is required.
Phototherapy available for babies with jaundice.

Arterial blood gas (ABG) analysis available on site SCN staffed by nurses with specialist neonatal and/or paediatric training, supervised by paediatricians.

   Provision of intensive and high dependency care, including medium term respiratory support (CPAP and mechanical ventilation) for small, extremely preterm and sick neonates, inborn or referred from other hospitals.
Separate Neonatal Intensive Care Unit (NICU) with intensive care (respiratory support) and high dependency/step down cots.

Access to paediatric surgery, blood gas monitoring, diagnostic services.

 NICU staffed by specialist neonatal nurses with consultant paediatrician available 24/7.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Specialist referral clinics provided by paediatric team and visiting paediatric specialist teams.
  Sub-specialist paediatric referral clinics provided by visiting teams including cardiology, endocrinology and haematology/oncology.

Service linkages with overseas paediatric referral hospital.

Paediatric inpatient care   Paediatric inpatient care for children admitted with medical conditions requiring more intensive observation, treatment or management.

Separation of infectious patients from those vulnerable to infection.
As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Paediatric inpatient care for children admitted following surgery or with more complex medical conditions.
Provision for high dependency care, including  Provision for paediatric intensive/high dependency care, including invasive monitoring and respiratory support, for seriously ill children referred from ED, OPD 53 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided  Opportunistic immunisation Paediatric HDU/ICU    Paediatric ward includes 1-2 beds equipped for close observation/monitoring of acutely ill children.
Ideally, these beds are isolated for better in infection control.

Paediatric intensive care unit (PICU) SMO from NRH available on call 24/7 for consultation.

Strictest infection control system applies.

oxygen and monitoring, for seriously ill patients.

Separate isolation space for infectious patients.

Paediatric HDU providing close observation, monitoring, oxygen and short-term (<24 hrs) respiratory support to acutely ill children.
Patients requiring higher level care or prolonged ventilation transferred to NRH.

Specialist high dependency nurses plus medical supervision by consultant paediatricians, with support from PICU specialists at NRH.

Strictest infection control system applies.

       and other hospitals/ health facilities.

Haematology/Oncology service including provision of chemotherapy for children with cancer.

Consultant paediatrician or registrar available 24/7 on site.
As for Regional Referral Hospital PLUS  Provision of complex life support including medium term mechanical ventilation, for critically ill children from all provinces.

 Medical supervision by designated SMO paediatrician/intensivist, on call 24/7.

 Nursing staff have specialist PICU training.

 Unit incorporates intensive care and HDU/stepdown beds, with bedside and central monitoring available.

Standard protocols and procedures in place.

Strictest infection control system applies.


24/7 availability of diagnostic, pharmacy and operating theatre services.

ABG on site.

Has formal links (training, consultation, clinical standards) with an intensive care service in a tertiary referral hospital overseas.

Provides consultant supervision to RRH and provincial hospitals.
     Adolescent health  ‘Youth friendly’ health services including health education, reproductive health, mind care, STI/HIV testing and diagnosis, counselling and referral to specialist services, provided in conjunction with Public Health As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Specialist medical consultation, treatment and referral provided in adolescent clinics by outreach paediatric team.
 Specialist medical consultation, treatment and ongoing management of adolescent patients with chronic/complex conditions.

54 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided services and NGOs.
 Consultation and referral to NRH for patients with chronic/complex medical conditions  Coordination of transitional care for patients transferring to adult medical care MENTAL HEALTH Mental Health/Psychiatry    Outpatient clinics, counselling, outreach and emergency on call service provided by specialist Mental Health nurse.

Visiting psychiatrist available for consultation and specialist outpatient clinics.

Secure room available for stabilisation of disturbed/aggressive patients.
Limited inpatient care for stable patients provided in general ward, supported by Mental Health nurse.

Discharge of patients for follow up/continuing care by referring health facility/practitioner   As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS    Specialist outpatient clinics and emergency consultation provided by Psychiatrist.

Day therapy program including occupational or diversional therapy support.
Short term inpatient care and early rehabilitation for stable patients provided in mental health unit.

    Coordination of national mental health consultation-liaison and emergency response service.

Accepts nation-wide referrals of patients with more serious/complex conditions and/or requiring longer-term admission.

Specialist procedures including ECT and psychotherapy services.

Separate mental health facility including inpatient and outpatient services.
ALLIED HEALTH/CLINICAL SUPPORT SERVICES Pharmacy and Central Medical Stores  Dispensing of medications as per Essential Drug List (EDL) including patient drug information and counselling.

 Management of drug supply to hospital and other health facilities, including receiving supplies from Central Medical Stores (CMS); inventory management, monitoring drug use and maintaining secondary store.

Dispensing of restricted medications (as per EDL).


  Maintenance of ward imprest system for As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS   Extended clinical pharmacy role: participation in ward rounds and committees eg NCD, HIV, Infection Control.

Arranging continuing supply/management of restricted medications for patients at provincial hospitals and health centres.

 Monitoring of patterns of drug use, investigate apparent over or under- prescribing.
Clinical supervision of pharmacy interns and      Specialised and extensive clinical pharmacy support across all departments, including participation in clinical trials Specialist pharmacy services including oncology pharmacy and manufacturing of paediatric medications.

Designated pharmacist responsible for national drug information/medicine safety service.
Technical support of electronic inventory 55 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Medical laboratory services  inpatient medications.

Provision of clinical pharmacy support and drug education to management, clinical staff and other health facilities.
 Monitoring and investigation of adverse drug          reactions Service provided by pharmacist, pharmacy technicians and supply officers.

After hours on call service available on site or within 60 minutes A range of essential diagnostic tests including o Haematology: routine tests incl.

FBC, electrolytes, malaria, parasites, o Biochemistry: routine automated tests.

o Microbiology: basic tests.


Eg urinalysis, stool & blood cultures, TB AFB microscopy o Serology (RDT): Hepatitis, HIV, STI, TB Specimen collection and preparation: transport to referral hospital laboratories as required.

Blood collection and banking, cross matching.

Access to pathologist consultation and autopsy service via RRH or NRH.

Laboratory surveillance and reporting of communicable diseases.

Annual audit using WHO Guidelines to monitor service quality.
After hours on call service available on site or within 60 minutes.

dispensers as well as pharmacy staff at Provincial Hospitals.

24/7 emergency service with after hours on call available on site or within 30 minutes.

Advises CMS Sub-Store and assists with distribution of medicines and medical supplies to other provincial facilities.

Teaching of nursing and medical students; regular participation in CME/CPD programs.
      management system at all health facilities Safe storage and disposal of cytotoxic drugs and expired medications.

Referral of adverse drug reactions to TGA and suppliers.

Liaises with CMS in relation to procurement, purchasing and distribution of medicines and medical supplies.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Basic histopathology (FNAB TB cytology, serology, PAP smear testing) and referral of tissues to national pathology service.
 Semi-automated blood culture  GeneXpert analyses  Urgent blood gas analysis  Laboratory Information System (LIS) provides results electronically to clinical areas and referring hospitals Service provided by laboratory scientists and technicians with access to pathologist consultation and autopsy service via NRH.

Local access to autopsy facilities 24/7 service with after hours on call available on site or within 30 minutes.
     Consultant pathologist and registrar and some specialised scientists and technicians on site.

Histology/cytology laboratory providing a range of services including frozen sections, biopsies, pleural effusions, bone marrow aspirates.

Immuno-assays   Molecular/DNA testing & genetic counselling  Media preparation (plates, broth)  National blood service including blood collection & supply of whole blood, plasma, platelets, packed cells, fresh frozen plasma & blood irradiation.
Autopsies performed by Pathologist with Laboratory Scientist support.

External support from Forensic Pathologist if required.
Participates in annual external audits to   56 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Medical imaging X-ray (fixed, digital) and ultrasound services   May have mobile X-ray and portable ultrasound   Medical Imaging service provided by medical imaging technicians or radiographers.

Access to radiology consultation from referral hospital.
After hours on call service available on site or within 60 minutes.

 Clinical investigations   ECG available in Emergency department and medical/surgical ward Basic endoscopy service may be provided by visiting specialists     monitor and benchmark service quality.

Conducts internal audit of provincial laboratories.

Production of national laboratory handbook, clinical guidelines and SOPs.

 National research laboratory  Laboratory service available on site 24/7.
As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Digital X-ray with monitors in radiology, ED, OPD and wards.

PACS linking with provincial hospitals   Mobile X-ray in ED  Full ultrasound service (colour doppler) plus portable ultrasound machines in antenatal clinic and maternity ward.
 Image intensifier in theatre  Orthopantomography (OPG)   Fluoroscopy (IVU and contrast studies) Service provided by medical imaging technicians or radiographers with access to consultant radiologist at NRH 24/7 service with after hours on call available on site or within 30 minutes.

A limited range of investigations may be provided, including: o o o ECG Echocardiography Endoscopy             Has consultant Radiologist and registrar.
Radiography staff include sonographers with specialist training.

Specialist radiologist reporting of X-rays and scans CT scanning available for selected patients in line with referral criteria.

Basic interventional radiology service (ultrasound guided procedures) Linked with referring hospitals and provides electronic images and reports via PACS (picture archiving & communication system).
Radiology nurse available Service available on site 24/7 ECG Exercise stress tests EEG Echocardiography Endoscopy, colonoscopy, bronchoscopy Spirometry Operating theatres +  Single operating theatre, staffed by trained  Operating theatre suite comprising at least As for Regional Referral Hospital PLUS 57 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided endoscopy Anaesthetics Sterilising and Infection Control         theatre nurses, provides for minor/moderate surgical and diagnostic procedures to be performed by local and visiting surgical staff.
Provides 24/7 cover for emergency caesarean sections.

Theatre has separate preparation, recovery and sterile store areas.

Strict infection control measures in place if clean and dirty procedures performed in same room.

Local, spinal and general anaesthetics on low risk patients, by MO with anaesthetic training or anaesthetic nurse.

Provides 24/7 cover for emergency caesarean sections.

Anaesthetist consultation available from referral hospital.
two theatres suitable for performing both major and minor procedures, with separate anaesthetic and recovery areas.

Provision for day only procedures to be performed with separate admission area and recovery lounge.

  Operating theatres staffed by trained theatre      nurses.

24/7 service with after hours on call available on site or within 30 minutes.
Anaesthetic service provided by anaesthetists, anaesthetic registrars and anaesthetic nurses, capable of providing general, regional, epidural and local anaesthetics, and sedation to low-moderate risk patients (ASA 1-3).

Pre-admission or pre-surgery screening/assessment provided in preadmission clinic or ward.

Provides support to ED, HDU and wards with emergency resuscitation; intubation, ventilation, insertion of central lines and acute post-surgical pain management.
24/7 service with after hours on call available on site or within 30 minutes.

    Service includes at least three main operating theatres, plus minor theatre, procedure room and endoscopy room, with separate anaesthetic induction areas and recovery area with 2 beds per theatre.

Theatres staffed by trained operating theatre nurses and anaesthetic nurses/technicians Theatres have ready access to ICU and easy access from delivery suite.
Service available on site 24/7 As for Regional Referral Hospital PLUS  Provision of anaesthetics/sedation for all categories of patients including high risk (ASA4) and children aged <5, undergoing surgery or diagnostic procedures in operating suite, endoscopy room or Radiology department.

Pre-admission review of patients with identified comorbidity or other risks.

 Management of ventilatory support for     patients in ICU and ED.

Service available on site 24/7.


Acute & chronic pain management service Coordinates formal audit process including review of deaths under anaesthetic Provides and operates a steam sterilisation system for all instruments, delivery packs and sterile linen packs.

Additional sterilising units in ED and dental areas.
As for Provincial Hospital PLUS As for Regional Referral Hospital  Formally appointed Infection Control Officer responsible for maintenance of cleaning and sterilising standards; monitoring and 58 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided      Cleaning team on site to maintain environmental hygiene Prevents and controls infection risk by practicing universal precautions.
Isolation of infectious patients Infection control committee and designated IC nurse in place.

Biomedical technician service providing routine maintenance and repair of biomedical equipment for hospital and provincial health facilities.

 Maintains equipment inventory and Biomedical engineering  coordinates equipment maintenance, repair and replacement program for all sites.

 Maintenance of workshop: storage and supply of spare parts and consumables.
Training of clinical staff in safe use, maintenance and cleaning of biomedical equipment.

Biomedical staff training, support and quarterly visits provided by biomedical team from referral hospital.

 Physiotherapy/Rehabilitation   Basic physiotherapy and exercise programs delivered by physiotherapist or trained therapy aide, supervised by local/visiting physiotherapist.
Visiting rehabilitation service provides physiotherapy service and assessment/referral for mobility aids/equipment for patients referred by reporting of hospital acquired infections; disease surveillance and investigation of outbreaks.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS        Provides routine maintenance/repair of all biomedical equipment in common use in hospital and provincial health facilities.
Advises on procurement of equipment and spare parts and on acceptability of donated equipment.

Service operates from separate, well equipped workshop.

Regional service provided by biomedical engineer, biomedical technicians and trainees.

Supervision/support of biomedical technicians and trainees, plus biomedical staff in provincial hospitals.

Rehabilitation service provided in designated area by physiotherapists and therapy aides.

May have occupational therapist.


Provides general physiotherapy services to inpatients and outpatients, as well as specialist rehabilitation programs eg amputee, stroke recovery, cardiac rehab.

 Maintains equipment pool and provides   Provides/arranges repair, maintenance and replacement of specialist biomedical equipment within the National Referral Hospital or referred from other hospitals.

Coordinates new orders across all facilities.


Coordinates National Biomedical Support Service, including basic training of technical staff; business planning; development of policy guidelines and operating policies/procedures; budget management/  Manages annual training and CPD programs for biomedical staff.

 Monitors turnaround times for repair/replacement: investigates delays and acts to prevent these.
As for Regional Referral Hospital PLUS  Multidisciplinary rehabilitation service including physiotherapy, occupational therapy, speech therapy and prosthetics & orthotics, provided on both inpatient and outpatient basis.

Inpatient care in designated Rehabilitation  59 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided    other health services.
Supply of wheelchairs and mobility devices Access to prosthetics services.

Coordination of provincial Community Based Rehabilitation (CBR) program; maintenance of register of people with disabilities; liaison with disability NGOs.

 assessment and access to wheelchairs and mobility aids.

Provide supervision to interns and outreach/visiting services, training and advice to staff at provincial hospitals.
 Works with community-based rehabilitation services to provide ongoing support to patients after discharge.

 unit, with access to therapy areas and gym shared with outpatient programs.

Coordinates nation-wide rehabilitation service through outreach visits; training and professional supervision of staff in provinces and management of CBR program.

Prosthetics/Orthotics  Has access to prosthetics services at RRH.
 As for Regional Referral Hospital Service provided by trained prosthetist/orthotist who assesses patients requiring prostheses and manufactures or orders appropriate prostheses or orthoses.

P&O manufacturing workshop located on hospital site.

Nutrition/dietetics   Visiting nutrition/dietetics service provided by Referral Hospital Basic nutrition advice to individual patients particularly those with lifestyle-related NCD.
 Maternal Infant and Young Child Feeding   (MIYCF) counselling including promotion of breast feeding for 6 months Special feeding programs for children with malnutrition.

Food service and clinical staff have access to nutrition training via National Public Health Nutrition program.

 Maintains close links with rehabilitation services and NGOs.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS      Service provided by dietitian based at hospital.
Advises food services on preparation of nutritious meals, special diets based on clinical conditions, food handling and safety.

Supervision of enteral feeding programs Participation in multi-disciplinary NCD clinics and malnutrition programs within hospital.

Provision of nutrition education programs and food preparation demonstrations for patients and families.
 Working with public health staff on consumer education programs promoting healthy diets Provision of outreach support to provincial    Coordination of integrated nutrition program with Public Health, providing nation-wide access to nutrition education, dietary advice and clinical management of nutrition/diet related illness, including NCD, malnutrition, anaemia.

Development and support of national nutrition guidelines for Food Services and dietary management of hospital patients.
60 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Counselling/social work/pastoral care Palliative care Health promotion      Limited counselling service provided by Mental Health nurse Coordination of counselling services provided through partnerships with churches, community groups and NGOs.
Care, advice on pain management and support to people living with terminal illness and their families, provided by medical officers and nursing staff with palliative care training, in conjunction with Public Health staff.

Designated palliative care bed adjacent to general ward, with care provided mainly by family members?

Pain management service may be provided in consultation with anaesthetic and clinical pharmacy staff at regional referral hospital.
 Other services may be provided through partnerships with churches, community groups and NGOs.

  Hospital provides health promoting environment: clean facilities, smoke-free, healthy food, promoting hand washing, physical activity etc … Individual health education provided to patients and their families by medical officers, nurses, pharmacist, dietician Health promotion included in job descriptions of all clinical staff.

 Group education/activity programs  hospitals.


As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Coordination of National Counselling program, providing training and support to counsellors and social workers working across the hospital system.

As for Regional Referral Hospital      Trained counsellor or social worker on site Staff trained in palliative care provide care and support, including pain management, to patients with terminal conditions.
Designated palliative care team may include medical, nursing, pharmacy, volunteers and other staff.

Inpatient care provided in designated palliative care area, adjacent to general ward.

Service linkages with churches and community groups: training provided to volunteers to provide community support.
As for Provincial Hospital As for Regional Referral Hospital 61 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Health Information/Medical Records conducted in both hospital and community outreach settings.

    Production, maintenance, filing and secure storage [hard copies and electronic] and archiving of medical records for all patients.
Collection of statistical data, coding and entry into Health Information System (HIS).

Production of monthly and annual HIS reports for use by managers in monitoring hospital utilisation and planning services.

Training and support of health workers in completion of forms and use of HIS data in decision-making.
MANAGEMENT/ADMINSTRATION Management & Administration   Functions include: o Provincial administration o Medical administration o Nursing services management o Management of Finance, HR, IT and General Services o Administrative/clerical support.

Ensure effective use of available resources to deliver the health services required to meet provincial needs.

 Maintain financial, HR, asset and other records and submit regular reports to MoH.
EDUCATION, TRAINING, SUPERVISION As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS    Provision of training and supervision of interns, filing clerks and provincial staff.

Research and preparation of ad hoc reports requested by managers and senior clinicians?

Provision of limited service on weekends and public holidays.

 Maintenance of national archive.
As for Provincial Hospital PLUS As for Regional Referral Hospital    Allied health services management Policy and planning support to region Supervision of provincial IT services and provision of specialist support 62 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Teaching, training, professional development Clinical support and Supervision      Identification of general and specialised training needed for staff to achieve standards required to provide key services.
Provision of an annual program to ensure staff have access to regular in-service training, updates and refresher courses, in conjunction with MoH Human Resource Development (HRD) officers.

Planning and coordination of CPD provided during specialist outreach/supervision visits.

Clinical supervision of medical and allied health staff provided via quarterly outreach visits from referral hospitals.
Clinical supervision of nursing staff by nurses in charge Clinical practice improvement unit  Service to be provided by a single dedicated trained senior nurse.

As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS          Arranges weekly CPD sessions for all clinical staff Coordinates medical student electives and volunteer placements.
Coordinates training, mentoring and clinical placement activities provided by visiting teams Clinical supervision of registrars and interns by consultants.

Provision of consultant advice, quarterly outreach/supportive supervision visits to provincial hospital clinical staff.

Clinical supervision of nurse interns by nursing supervisors/nurses in charge Allied health interns supervised by senior staff, with specialist updates provided by visiting NRH staff Coordination of clinical research activities.
Service to be provided by up to 3 trained staff responsible for risk management, infection control & customer service.

 Manages medical training program including placement, rotation and assessment of interns and registrars within the hospital.

As for Regional Referral Hospital PLUS   Functions as teaching hospital for final year undergraduates and post-graduate trainees studying overseas.

Planning and coordination of national clinical research programs.
As for Regional Referral Hospital GENERAL SUPPORT SERVICES Kitchen/food service  Manages ordering, supply, safe storage and timely use of fresh and frozen foods and dry goods.

Provides nutritious meals and special diets  As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Dietitian prescribes special diets and provides nutrition education to food services staff.
 Dietitian based in kitchen 63 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided    for patients, with dietitian advice if available.

Ensures standards of food safety and kitchen hygiene are met and staff are fully trained to do this.

Collects soiled linen and scrubs/lab coats; wash, dry and supply clean linen etc to wards and outpatient areas.
Ensures standards of hygiene and infection control are met and staff are fully trained to do this.

 Maintains standards of environmental cleanliness and hygiene by cleaning all surfaces throughout the hospital.

Provides additional cleaning/disinfecting in areas of cross infection risk.

   Provides ambulance plus vehicles for staff transport and general courier/on call duties.

Provides basic CPR and paramedical training for ambulance drivers.
 Mechanical maintenance and regular servicing of all vehicles.

Transfer of patients, equipment/supplies and communications between areas of the hospital.

Transfer of bagged waste from clinical areas to collection points.

   Housekeeping: Laundry/linen and cleaning.


Transport - patient and general Porters/wardsmen Security As for Provincial Hospital As for Regional Referral Hospital As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS  Provides ambulance fleet - 3 vehicles driven by drivers trained as paramedics including 4WD vehicles.
  Intensive care ambulance Patient transport vehicle for airport and local transfers As for Provincial Hospital As for Regional Referral Hospital As for Provincial Hospital PLUS Protection of hospital, staff, equipment, patients 24/7; reporting of all incidents.
 Closed circuit TV/video surveillance provided As for Regional Referral Hospital 64 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Communications/switchboard Mortuary      Emergency phone number available 24/7.

Separate number for routine calls: extensions in all wards and departments.
Teleconferencing facility available Refrigerated storage available for 4-6 bodies, with table for body preparation and viewing area for relatives and.

Access to autopsy service at referral hospital.

in vulnerable areas As for Provincial Hospital PLUS As for Regional Referral Hospital      Emergency number staffed 24/7 by trained telephonist/clerical officer.

Consultants, nurses in charge and on call clinical staff all contactable by mobile phone or pager, with numbers listed at main switchboard.
Switchboards with automated answering voice for quick response eg when telephonist busy Refrigerated storage available for at least 6 bodies, with table for body preparation and viewing, plus gathering area for relatives.

Access to autopsy facilities, and autopsy service by pathologist from NRH.

 Refrigerated storage for 8-10 bodies plus a freezer with capacity for storage of 2 bodies.
 Mortuary staffed by mortuary technicians (‘morgue men’) responsible for preparation, viewing and transfer of bodies to funeral homes, and assist with autopsy.

Beyond the short term, viewing and for relatives to gather may be outsourced.

Autopsies performed by consultant pathologist.

  Waste Management  Management of waste from hospital and As for Provincial Hospital As for Regional Referral Hospital    selected waste from other health facilities.
Sorting/segregation of all waste, recycling/reusing where possible.

Disposal of infectious waste material and other medical waste via high temperature incinerator.

Safe disposal of sharps, chemicals, corrosives, dangerous and radioactive waste.
65 SERVICE CATEGORY Provincial Hospital - Services to be provided Regional Referral Hospital (RRH) -Services to be provided National Referral Hospital (NRH)- Services to be provided Maintenance and grounds  Management of basic water supply and adequate sanitation/sewerage arrangements.

 Provision of general maintenance of buildings and equipment including carpentry, plumbing and electrical trades.

 Monitoring physical condition of infrastructure, plan and supervise maintenance/repair work.
 Maintenance and tidying of external lawn and garden areas; cleaning of paved areas.

As for Provincial Hospital As for Regional Referral Hospital Hostel/waiting house  May have access to simple, self-contained accommodation for patients and families referred from outlying areas.
 As for Regional Referral Hospital Simple self-contained accommodation on or near hospital for women with high risk pregnancies transferred antenatally from other provinces and parents of babies in NICU or paediatric ward without local accommodation.
66 APPENDIX C: FACILITY STAFFING REQUIREMENTS 67 APPENDIX C1: PRIMARY CARE STAFFING REQUIREMENTS Aid Post Title Village Health Worker Basic Qualification / Work Requirements A Village Health Worker is an informal health worker trained to achieve specific, necessary skills and practices and to understand the limitations of their skills and experience and the boundaries of their scope of practice.
Prior to commencing health practice the VHW should: - Have completed a Village Health Worker (VHW) Pre-Service Training (PST) During service, the VHW should conduct: - Approved In-Service Training (IST) - Other refresher coursing or skills enhancement support of the code of conduct - Enhanced skills training in case of emergency response requirements (I.e Based on disaster response requirements) In addition to service provision requirements, specific roles include: - Facilitate operation and maintenance of the Aid Post - Provide health updates to Aid Post Committee - Provide health information reports to next higher level of facility - Collect and record AP user fee for outpatient consultations 68 Dispensary Title Registered nurse Basic Qualification / Work Requirements In order for the health facility to be able to deliver health services as listed, conduct public health interventions and to manage a dispensary, the basic skills needed are found in a registered nurse who has undergone a set of training, orientation and capacity building as follows: - Successfully completed a Diploma of Nursing at Vanuatu College of Nursing Education, VCNE, or another recognised training institution as a minimum qualification.
- At least 1 year of supervised internship as a recognised accreditation facility.

- At least 2 years assignment to a health centre, supervised by a senior midwife or a nurse practitioner.

- Orientation and Induction before deployment – every registered nurse should undergo an orientation by appropriate personnel to outline and clarify roles and responsibilities, administrative and management processes, financial processes and accountability and reporting mechanisms.
For new assignments, the nurse should be taken to her new work station by her Supervisor who goes over the three sets of functions listed above.

If possible a handover is facilitated with the nurse who had previously worked in this dispensary.

Nurse Aide The nurse aide’s role is to assist the registered nurse in specific areas.

A nurse aide should have completed the approved / accredited training for nurse aides, and possess good knowledge of community engagement.
The specific roles include: Sterilisation of equipment Provide wound cleaning and dressings - - Cleaning of dispensary including laundry and general hygiene practices - - Assist the nurse to take vital signs – take BP, temperature, pulse, breathing rate - Collect and record clinic user fee.
- Assist in community engagement activity 69 Remote Dispensary Title Midwife Basic Qualification / Work Requirements In a number of dispensaries due to their remoteness and difficulty in being able to quickly organize life-threatening medical evacuations to a referral hospital (eg, maternity conditions such as excessive bleeding during delivery, retained placenta, breech delivery).
The midwife’s critical role is to provide maternity services for women including antenatal care, labour & delivery, postnatal care and newborn care.

She is also responsible for family planning including IUD insertion, Jadelle insertion and appropriate maternity care referrals.

She supports and supervises the MCH team including vaccination, IMCI and infant feeding and deputizes for the nurse practitioner where and when appropriate.
The midwife should have: successfully completed a Diploma of Midwifery training course at VCNE or other recognised training institution, - - have a minimum of two years’ experience working in hospital maternity ward settings, and - Have a minimum of two years’ experience working in a health centre setting under a nurse practitioner.
Every midwife should undergo an orientation by appropriate personnel to outline and clarify roles and responsibilities, administrative and management processes, financial processes and accountability and reporting mechanisms.

For new assignments, the nurse should be taken to her new work station by her Supervisor who goes over the three sets of functions listed above.

If possible a handover is facilitated with the nurse who had previously worked in this dispensary.
Nurse Aide The nurse aide’s role is to assist the registered nurse in specific areas.

A nurse aide should have completed an approved / accredited training course for nurse aides, and possess good knowledge of community engagement.
The specific roles include: Sterilisation of equipment Provide wound cleaning and dressings - - Cleaning of dispensary including laundry and general hygiene practices - - Assist the nurse to take vital signs – take BP, temperature, pulse, breathing rate - Collect and record clinic user fee.
- Assist in community engagement activity 70 Health Centre Title Basic Qualification / Work Requirements Nurse practitioner The nurse practitioner assumes the role of health facility manager while maintaining his/her clinical skills, contributing to delivery of health services.

The nurse practitioner should have accomplished the following: Midwife Public health and management experience.

- Registered Nurse with post graduate nurse practitioners qualification.
- - Orientation and Induction before deployment – the nurse practitioner should undergo an orientation by appropriate personnel to outline and clarify roles and responsibilities, administrative and management processes, financial processes and accountability and reporting mechanisms.

For new assignments, the nurse practitioner should be taken to his/her new work station by the provincial health manager who is the supervisor and who will go over the three sets of functions listed above.
If possible a handover is facilitated with the nurse practitioner who had previously worked at the health centre.

The midwife’s critical role is to provide maternity services for women including antenatal care, labour & delivery, postnatal care and newborn care.

She is also responsible for family planning including IUD insertion, Jadelle insertion and appropriate maternity care referrals.
She supports and supervises the MCH team including vaccination, IMCI and infant feeding and deputizes for the nurse practitioner where and when appropriate.

The midwife should have successfully completed the Diploma of Midwifery course and gained experience working in maternity ward settings.

Like all other health facility staff, there must be 0rientation and Induction before deployment, similar to that of the nurse practitioner outlined above.
Registered nurse The basic skills and experience required by a registered nurse who has undergone a set of training, orientation and capacity building are as follows: - Successfully completed a Diploma of Nursing at Vanuatu College of Nursing Education, VCNE, or another recognised training institution as a minimum qualification.

- At least 1 year of supervised internship as a recognised accreditation facility.
71 Title Basic Qualification / Work Requirements - Like all other health facility staff, there must be Orientation and Induction before deployment, similar to that of the nurse practitioner outlined above.

Nurse Aid The nurse aid’s role is to assist the registered nurse in specific areas.

A nurse aid should have completed an approved / accredited training course for nurse aids, and possess good knowledge of community engagement.

The specific roles include: Sterilisation of equipment.
Provide wound cleaning and dressings.

- - Cleaning of dispensary including laundry and general hygiene practices.

- - Assist the nurse to take vital signs – take BP, temperature, pulse, breathing rate.

- Collect and record clinic user fee.

- Assist in community engagement activity Driver and Handyman The driver/handyman drives for the HC and undertakes the tasks of a grounds man in maintenance work that might be required for the HC and staff housing.
He also carries out minor repairs when needed for nearby dispensaries that fall within the zone in which the HC is located and provides supervisory support.

The driving tasks include – pick up of medicines and supplies from Central Medical Store or pharmacy, transport of medical evacuation to referral centre, and take outreach teams to communities on scheduled dates.
Note: Staff requirements for Health Centres include a driver/handyman who is expected to undertake minor repairs when needed for nearby Dispensaries or Remote Dispensaries that fall within the zone in which the Health Centre is located and to which the Health Centre provides supervisory support.
72 Enhanced Health Centre Title Basic Qualification / Work Requirements Rural Physician The Rural Physician assumes the role of health facility manager while maintaining his/her clinical skills, contributing to delivery of health services.
The Rural Physician should have accomplished the following: - Completed a Bachelor of Public Health qualifications provided by an accredited organisation - Completed an internship at a recognised accredited facility and be registered as a health practitioner - Completed a minimum of 2 years in a hospital setting prior to movement into a rural setting Orientation and Induction before deployment – the Rural Physician should undergo an orientation by appropriate personnel to outline and clarify roles and responsibilities, administrative and management processes, financial processes and accountability and reporting mechanisms.
For new assignments, the Rural Physician should be taken to his/her new work station by the Provincial Health Manager who is the supervisor and who will go over the three sets of functions listed above.

If possible a handover is facilitated with the Rural Physician or other health staff who have previously worked at the health centre.

Is responsible for: Provision of clinical and public health services based on scope of practice and trained level.
- - Contributing to the planning and implementation of health services within the zonal and provincial boundaries across Public Health and Hospitals & Curatives Service components.

- Administration of the Enhanced Health Centre, inclusive of planning, finance, human resource management and other administrative services.

- Maintenance of quality management systems for health service provision.

- Supportive Supervision of subordinate facilities and health personnel.
- Capacity development of health professionals within the Enhanced Health Centre (EHC) and health zone.

- Health Information Systems (HIS) Reporting on a regular basis or immediate (if notifiable) Nurse practitioner The nurse practitioner assumes the role as second in charge of health facility under the Rural Physician while maintaining his/her clinical skills, contributing to delivery of health services.

73 Title Basic Qualification / Work Requirements Remainder as per Health Centre requirements.
Midwife As for Health Centre Registered nurse As for Health Centre Nurse Aid As for Health Centre Driver and Handyman As for Health Centre 74 APPENDIX C2: HOSPITAL STAFFING REQUIREMENTS PROVINCIAL HOSPITALS See table at Attachment 1.
REGIONAL REFERRAL HOSPITAL Medical staffing: increase in resident medical specialist cover in the areas of  Emergency medicine  Internal medicine  Surgery  Anaesthetics/HDU  O&G  Paediatrics/Neonatal Minimum staffing in these areas = 2 x consultant/senior registrar; 1 x junior registrar/MO plus 1 intern per specialty.
Medical staff to be responsible for covering inpatient, outpatient and emergency on call services plus consultancy support/supervision of staff in provincial hospitals and health facilities.

Specialist consultant cover to be provided from NRH in  Surgical subspecialties  Psychiatry  Pathology  Radiology These services to be supervised at RRH level by a registrar or MO with specialist focus.
Specialist trained nurses – required for  Emergency department  Critical care/HDU (adult and paediatric) 75  NCD clinic: diabetes, footcare, eye, nutrition  Medical ward  Surgical ward  Women’s health clinics  Paediatrics  Special care nursery  Mental health outpatient clinic (also support inpatient)  Operating theatres  Anaesthetics  Palliative care  Infection control Midwives & Senior Midwives required for  Antenatal/postnatal clinics (including high risk)   Maternity ward Labour and delivery Nurse staffing levels Beyond minimum cover, to be determined on a patient caseload and dependency basis.
Outpatient staffing levels – medical, nursing and other cadres  Refer proposed outpatient staffing standards at Attachment 2.

Allied Health/Clinical Support  Refer proposed minimum staffing standards at Attachment 3.
NATIONAL REFERRAL HOSPITAL 76 Medical staffing: increase in resident medical specialist cover in the areas of  Emergency medicine  Internal medicine  Surgery  Anaesthetics/HDU  O&G  Paediatrics/Neonatal Minimum staffing in these areas = 3 x consultant/senior registrar; 1 x junior registrar/MO plus 1 intern per specialty.

Model is generalist with specialist focus.

This will allow for some sub-specialisation within core staffing.
Specialist consultant/SMO staffing to be upgraded in:  Psychiatry (2 x SMO)  Pathology (1 x SMO, 1 x trainee)  Radiology (1 x SMO, 1 x trainee) Medical staff to be responsible for covering inpatient, outpatient and emergency on call services plus provision of specialist support and supervision to staff at RRH and some provincial hospitals.
Specialist trained nurses – required in: ICU/HDU (adult and paediatric)  Emergency department (adult and paediatric)   NCD clinic: diabetes, footcare, eye, nutrition  Medical ward  Surgical ward  Oncology/chemotherapy  Women’s health  Paediatrics  NICU  Mental health  Operating theatres 77  Anaesthetics  Palliative care  Infection control Clinical nurse consultant positions as an alternative career pathway for clinical specialist nursing.
Midwives & Senior Midwives – as for RRH Outpatient staffing levels – medical, nursing and other cadres  Refer proposed outpatient staffing standards at Attachment 2.

Allied Health/Clinical Support  Refer proposed minimum staffing standards at Attachment 3.
78 Category Medical Superintendent Nursing Services Manager Manager General Services Medical Officer - general Nurse Aide Registered Nurse Midwife Nurse Practitioner Eye nurse ENT nurse Mental health nurse ASO/Nurse Anaesthetist Dental Officer/dentist Dental therapist Dental assistant Laboratory technician Assistant Laboratory technician Medical imaging technician Pharmacist Pharmacy Dispenser Pharmacy technician Supply officer (pharmacy) Therapy Aide Biomedical technician HIS officer Medical records officer Medical records clerk Secretary/receptionist APPENDIX C2: ATTACHMENT 1 - MINIMUM STAFFING STANDARDS (PROVINCIAL HOSPITALS) Minimum Number 1 1 1 2 Notes Nurse staffing numbers depend on size of hospital and level of activity.
At least one midwife is required per shift.

1 1 1 2 1 1 1 2 1 2 1 1 1 1 1 1 1 1 2 2 Structure = 4 (incl.
1 NP) + 1 nurse aide Structure provides for 3 + 1 nurse aide Structure = 1 ASO, 2 Nurse Anaesthetist Structure provides + 2 microscopists Ideally should include 1 sonographer Structure provides for 3 Structure provides for 3 Structure provides for 2 Structure provides for 3 Structure provides for 1 Physiotherapist Not in structure Includes coding role Structure provides for 3 79 Category Finance officer Clerical Housekeeping supervisor Cooks Laundry, tailor Cleaners Porter Maintenance supervisor Maintenance staff Driver Security Minimum Number 1 1 1 2 2 4 2 1 2 2 1 Structure provides for 2 Structure provides for 5 Structure provides for 5 Structure provides for 3 Handyman, groundsman Notes 80 APPENDIX C2: ATTACHMENT 2 - STAFFING STANDARDS (OUTPATIENT SERVICES) Assumes average clinical productivity of 43 weeks per year (accounts for annual & sick leave, public holidays, training days etc) and average 10% administrative time (ie 9 sessions per week for full time outpatient staff).
Numbers of sessions depend on demand for individual services … may be varied.

Note: FTE = Full-time equivalent A nurse who works 3 days per week (6 sessions) = 6/10 or 0.6 FTE Note that contact duration (minutes per contact); sessions per week and assumed weeks per year are all subject to variation.

Outpatient caseload analysis Minutes/contact (Average) Contacts per hr Sessions per wk Hrs per wk* Contacts per week Contacts p.a (4 hrs/session) (43 wks p.a.)
Consultant Medical Officer Dentist Dental Therapist/hygienist Nurse Practitioner Midwife RN Nurse Aide Physiotherapist Radiographer Sonographer CT Scanning technician Clinical pharmacist Pharmacy dispenser Lab technicians 15 20 45 TBD TBD TBD 6 3 1.3 TBD TBD TBD 9 9 9 TBD TBD TBD 36 36 36 TBD TBD TBD 144 108 46 TBD TBD TBD 6192 4644 2012 TBD TBD TBD FTE staffing = projected demand (contacts) divided by average caseload.
For seven day coverage, multiply FTE by 1.4.
82 SERVICE CATEGORY Pharmacy Medical laboratory services & Blood Bank Medical imaging Operating theatres + endoscopy Anaesthetics Sterilising & Infection control Biomedical engineering APPENDIX C2: ATTACHMENT 3 - MINIMUM STAFFING (RRH & NRH) – ALLIED HEALTH/CLINICAL SUPPORT REGIONAL REFERRAL HOSPITAL NATIONAL REFERRAL HOSPITAL Pharmacy Manager Senior pharmacist x 2 Pharmacy dispenser x 4* Pharmacy assistant x 2 Pharmacy intern x 1 Supply Officer x 2 Laboratory OIC Senior Lab Tech x 3 Lab.
Technician x 3 Lab assistant x 3 Phlebotomist x 2 Blood donor recruitment officer x 1 Lab Tech Intern x 1 Medical Imaging OIC Senior MI Technician x 2 MI Technician x 2 MI Intern x 1 Theatre Manager/Nurse in charge RNs (spec) SMO x 2 MO x 1 Intern x 1 Nurse Anaesthetist x 3 Anaesthetic Technician x 1 Nurse in charge NA x 3 Technician in Charge Technician x 2 Pharmacy Manager Senior pharmacist x 4 Pharmacist x 2 Pharmacy dispenser x 6* Pharmacy assistant x 2 Pharmacy intern x 1 Supply Officer x 4 Principal Laboratory Officer Section OIC x 6 Senior Lab Tech x 6 Lab.
Technician x 6 Lab assistant x 3 Blood donor recruitment officer x 1 Phlebotomist x 2 Lab Tech Intern x 1 Principal Medical Imaging Officer Senior MI Technician x 3 MI Technician x 4 MI Intern x 1 Theatre Manager/Nurse in charge RNs (spec) SMO x 3 MO x 2 Intern x 1 Nurse Anaesthetist x 3 Anaesthetic Technician x 1 Nurse in charge NA x 5 Manager, National Biomedical Service Senior Biomedical Technician x 2 83 SERVICE CATEGORY REGIONAL REFERRAL HOSPITAL NATIONAL REFERRAL HOSPITAL Physiotherapy/Rehabilitation Prosthetics/Orthotics Nutrition/dietetics Counselling/social work/pastoral care Palliative care Health promotion Health information/medical records Physiotherapist in charge Physiotherapist x 1 Occupational Therapist x 1 Therapy aide x 2 Prosthetist/Orthotist x 1 Technician x 1 Senior Dietitian x 1 Dietitian x 1 Dietary assistant x 2 Counsellor x 1 RN (spec) x 1 Biomedical Technician x 2 Biomedical Technician Intern x 1 Manager, Physiotherapy & Rehabilitation Physiotherapist x 2 Occupational Therapist x 1 Speech Pathologist x 1 Physio intern x 1 Therapy aide x 2 Prosthetist/Orthotist x 1 Technician x 1 Manager, Nutrition & Dietetics Senior dietitian x 2 Dietary assistant x 2 OIC Counselling service Counsellor RN (spec) x 2 Health Promotion Liaison Officer x 1 Health Promotion Liaison Officer x 1 Senior HIS Officer HIS Officer x 2 Medical Records Officer/Coder x 2 Medical Records Clerk x 4 Manager Health Information Senior HIS Officer HIS Officer x 2 Medical Records Officer/Coder x 3 Medical Records Clerk x 8 84 APPENDIX D: FUNCTIONAL SPACE AND UTILITIES ATTACHMENT D1: PRIMARY CARE FUNCTIONAL SPACE AND UTILITIES Key: Aid Post (AP), Dispensary (D), Remote Dispensary (RD), Health Centre (HC), Enhanced Health Centre (EHC) PRIMARY CARE FACILITIES - FUNCTIONAL SPACE Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 1 Consultation Room 1 1 1 2 2 2 Treatment / Procedure Room 1 1 1 1 1 3 Inpatient (Male) Ward 0 1 1 1 1 Room suitable for private consultation with patient and carer (if applicable).
Ability to house nurses station, examination bed, basic diagnostic equipment, communications equipment, reference material, and patient files.

Access to outpatient waiting area and clinical treatment room.

Room suitable for treatment of single patient with carer support (if required).

Ability to house nurses station, treatment bed, first aid and other medical equipment.

Access to consultation and pharmaceutical storage areas.
Room suitable for housing two (2) inpatients at one time with ability to store personal effects, allow for visitors, and support inpatient meals in situ.

Provision of privacy for further assessment and observation through non-intrusive means.

Access to ablution areas.

12 10 10 10 10 0 13 13 13 13 0 12 12 12 12 Supporting Utilities Ability to communicate through voice and / or data mediums.

Supported by power supply.

Access to infection control fittings.


Supported by power supply for provision of examination and general lighting.

Access to infection control facilities with running water.

Supported by general lighting systems.


86 Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 4 Inpatient (Female) Ward 0 1 1 1 1 5 Inpatient Maternity Ward 0 0 1 1 1 6 Delivery Room 0 0 1 1 1 7 Pharmaceutical Storage 1 1 1 1 1 Room suitable for housing two (2) inpatients at one time with ability to store personal effects, allow for visitors, and support inpatient meals in situ.
Provision of privacy for further assessment and observation through non-intrusive means.

Access to ablution areas.

Room suitable for housing 2-3 inpatients at one time and 2-3 cribs with ability to store personal effects, allow for visitors, and support inpatient meals in situ.

Provision of privacy for further assessment and observation through non-intrusive means.

Access to ablution areas.

Room for housing delivery bed, ability to accommodate three (3) staff at one time.
Close to inpatient Maternity and pharmaceutical storage and provide access to ablutions.

Room for housing pharmaceutical storage, cold chain, sterilisation equipment, sorting table and nurses station.

Ability to support laboratory / diagnostics area.

Adjacent to treatment room and Delivery room, close to inpatient wards.

0 12 12 12 12 0 0 14 14 14 0 0 10.5 10.5 10.5 12 10.5 10.5 10.5 10.5 Supporting Utilities Supported by general lighting systems.
Supported by general lighting systems and additional power supply for night lighting (low light).

Access to running water and sluice area.

Supported by General and examination lighting and ability to operating low power equipment as required.

Access to medical gas supply.

Access to running water and reagent disposal.

Supported by general lighting and provision of power for low power applications.
Access to gas lines for sterilisation of equipment (non- electric) 87 Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 8 Waiting Area 0 1 1 1 1 9 Ablutions (WC) - Internal 0 2 3 3 3 10 Ablutions (Shower) - Internal 0 2 3 3 3 11 Laundry 0 1 1 1 1 12 Sluice 0 1 1 1 1 Room for seating for outpatient consultation, covered from inclement weather.
Ability to change the waiting area to training area with notice board / black board option for presentations.

Inclusive design with ramp and stair access.

Adjacent to consultation room.

Ability to be closed to remainder of the facility.

Access to external ablution areas and water supply.

Separate Male and Female ablutions for staff and inpatients only.

Ability to access via wheelchair or place additional aids.

Adjacent to inpatient wards and delivery room.


Separate Male and Female ablutions for staff and inpatients only.

Ability to access via wheelchair or place additional aids.

Adjacent to inpatient wards and delivery room.

External facilities suitable for handwashing soiled linen and other cleaning items.

Complete with stainless steel tubs and faucets, angle grill for non-abrasive washing and drainage linked to grey water waste areas.

If external, can be part of undercover drying area for laundry items.
Internal or external facilities for disposal of bodily fluid waste (not excrement) and birthing waste.

Linked to septic tank system.

Accessible from in-patient wards and delivery room.

3 15 15 15 15 0 6 6 6 6 0 10 10 10 10 0 2 2 2 2 0 0.5 0.5 0.5 0.5 Supporting Utilities Access to running water and external ablutions as well as handwashing facilities.

Supported by general lighting.

Additional infection control dispensing measure to be in place Access to water for flush system and handwashing.
Toilet discharge to brown water waste, hand basin to grey water waste.

Access to water for gravity fed showering system.

Discharge to grey water waste.

Access to running water.

External general lighting to be provided for working by night.

Access to brown water waste system and running water for flush.

Access to hand washing facilities.


88 Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 13 Sterilisation 0 1 1 1 1 Internal area for sterilisation through use of power, or fuel system.

Can utilise existing space.


0 1 1 1 1 External Water and Sanitation Health 13 Ablutions (WC) - External 2 2 2 2 14 15 16 17 Ablutions (Shower) - External Grey Water Waste Brown Water Waste Roof Water Catchment System 2 2 2 1 1 1 1 1 1 1 1 1 2 1 1 1 18 Well / Local Water Supply 1 1 1 1 Double Ventilated Improved Pit (VIP) Toilet external to health facility with lined pit.

Separated male / female individual toilets.

Access to hand washing facilities and other hand sanitation consumables.
Basic shower facilities separated for male and female.

Access to external ablutions and other hand sanitation facilities.

Grey water waste disposal separated from VIP.

Waste pit discharge area with appropriate soak away construction Multi-chambered septic tank capable of holding effluent based on facility size, catchment population and expected usage rates.

Treated water discharge to appropriate soakaway.

Water capture system from roof catchment into existing water tanks or underground tanks systems.
Water capture from local supply or within health facility via piping or pumping system to health facility for storage in above ground or below ground tanks.

0 3 3 3 3 0 5 5 5 5 0 N/A N/A N/A N/A 0 N/A N/A N/A N/A 0 N/A N/A N/A N/A 0 N/A N/A N/A N/A Supporting Utilities Adjacent to Pharmaceutical Storage units Water storage for handwashing only.

Water storage with gravity feed system.
Lines from all grey waste areas Lines from all brown waste areas Piped to health facility with appropriate yield Piped to health facility with appropriate yield 89 Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 19 Generator Shed 1 1 1 1 20 Drying Shed / Area 0 1 1 1 1 21 Waste Management and Storage 0 1 1 1 1 22 Garage 0 0 0 1 1 Covered facility for housing of generator or battery bank for solar systems.
Ventilated, protected from weather conditions.

Ability to exhaust fumes.

Provision of space for drying of clothes bedding and other linen.

Open are facility, with ability to be used for roof water catchment to feed into water tanks.

Incineration system for medical and general waste.

Certified to dispose of glass and needles plus any combustable biohazard waste.

External shelter able to provide cover for 1 x vehicle.
Able to be used for water catchment system feed to water tanks 0 2 2 2 2 0 0 0 0 0 0 3 4 4 4 0 0 0 15 15 23 Workshop 0 0 0 1 1 Standalone workshop for driver / cleaner for storage of tools, minor repair works.

Can be part of vehicle shelter.

0 0 0 6 6 24 Waiting Home 0 0 1 1 1 Provision of living quarters for up to 3 families to be provided for short to long term stay in preparation for child birth.

Separated family rooms with security screens and locks.
Access to ablutions inclusive external toilets, showers.

All ablutions to be separated male / female.

0 0 TBD TBD TBD Supporting Utilities Access to MDB in staff housing / medical facilities Adjacent to water storage areas Distance from medical facility, long chimney flume.

Adjacent to water storage areas, can be the roof catchment area.
Adjacent to garage TBC – Policy to be amended once standardised designs are finalised 90 Serial Functional Area Room Requirement AP D RD HC EHC Area Description Spatial Requirement (m2) AP D RD HC EHC 25 Kitchen 0 1 1 1 1 Kitchen facility for preparation of patient meals and for use by families utilising maternity waiting homes.

0 12 12 12 12 Supporting Utilities Distance from medical facility, downwind.
STAFF HOUSING 26 3 Bedroom Staff House 0 0 0 2 3 2 bedroom house consisting of verandah, master bedroom, 2 x other bedrooms, kitchen, ablutions, laundry, septic tank, water storage, and boundary fence 0 0 0 148 222 TBC TOTAL SPATIAL REQUIREMENTS 0 74 74 148 222 27 2 Bedroom Staff House 0 2 2 2 2 2 bedroom house consisting of verandah, master bedroom, 1 x other bedrooms, kitchen, ablutions, laundry, septic tank, water storage, and boundary fence 0 130 130 130 130 TBC TOTAL SPATIAL REQUIREMENTS 0 130 130 130 130 91 PRIMARY CARE FACILITIES - ADDITIONAL UTILITIES Serial Utilities Example Description AP D RD HC EHC Establishment of standing water tanks on hardstanding or compacted coral areas with tie down for cyclone protection.
Water catchment via roof water capture system, well draw and delivery system or other gravity fed natural flow or banked tank systems.

Distribution via gravity system for utilisation within health facilities, particularly for handwashing facilities.

Provision of solar power supply through roof mounted or pole mounted solar array, with battery bank, control panels and load limiters.

Provision of generator support services linked to established electrical lines.
Connection to mains power (GRID) through establishment of meter box on site and connection to wired infrastructure.

1 Water Supply 2 Power Supply - Able to access - 10,000 Litre - 15,000 Litre - 30,000 Litre As for Health Centre water from local source and store up to 5,000L within proximity of Aid Post for exclusive use.

system.

Delivery to Consultation and Treatment areas, and any ablutions system.

Delivery to consultation, treatment and delivery areas, and any ablutions system.
Delivery to consultation, treatment and delivery areas, and any ablutions As for Health Centre As for Dispensary, plus - Lighting to delivery and Maternity inpatient ward.

- Provision of 50W Solar lighting package with 2-3 light fittings, solar panel, and ability to charge cellphone - Provision of 300W solar power system with establishment of lighting in each room.

External lighting for waiting / Health Promotion area.

Back up 5kVa generator with ability to link to established electrical systems.
Separate solar or generator lighting systems for staff housing.

- Provision of 1000W solar power system with establishment of lighting in each room including delivery and maternity inpatient ward.

External lighting for waiting / Health Promotion area.

Back up 5kVa generator with ability to link to established electrical systems.

Separate solar or generator lighting systems for staff housing.

92 AP D RD HC - Cellphone and - Cellphone or access to voice and SMS only.
Ability to access credit provided by MOH for services.

Desktop phone (sim capable) for access to voice and SMS only.

- Access to calling circle within provincial area.

- Access to As for Aid Post plus: As for Dispensary, plus: As for Remote Dispensary plus: - Low Power laptop and printer to utilise Data capability.

- Provision of tablet for mobile pharmaceutical supply ordering system, supervisory visits and surveillance.
EHC As for Health Centre Serial Utilities 3 Communications Example Description Ability to access voice, SMS and Data through connection to private ICT provider, through satellite communications or Government Broadband Network (GBN).

Provision of improved toilets, hand washing facilities inside and outside facilities and waste disposal facilities for grey and brown waste.

Ability to dispose of solid biomedical waste through approved practices.
4 Sanitation Services community latrines or Ventilated Improved Pit Toilets.

- Access to hand washing facilities (such as tippy-tap) As for Dispensary, plus: As for Remote Dispensary As for Health Centre - Ability to dispose of maternal waste (e.g placenta) - Handwashing facilities inside delivery units - Establishment of fuel powered incineration system - Separated liquid waste to established grey and brown water waste facilities.
- Backload of biomedical waste to Health Centre for Disposal or establishment of "kiln" type incineration system - Hand washing units inside consultation, treatment and sluice areas - Handwashing facilities inside ablutions 93 Serial Utilities 5 Security Example Description Establishment of external active or passive security measure for the facility or incorporation of additional security measures for the facility, such as boundary fences, secure storage facilities, or separation of services - Ability to secure pharmaceuticals in ventilated storage area within main consultation room.
As for Dispensary plus: As for Remote Dispensary - Security for maternity inpatients facility.

AP D RD HC EHC As for Health Centre - Establishment of security fencing around the Dispensary Facility, and staff housing.

- Lockable health facility and pharmaceutical storage area.

- Ability to secure generator and other fixed assets outside the facility As for Aid Post: - Support provided by Health Centre.

Provision of Quad bike for local support services.


6 Transport Services Access to transport services available within local area.

Provision of transport services such as motorbike?

quad, boat, or vehicle for provision of MOH owned transport services.

Access to local port, landing zone or airfield infrastructure for referral system.

- Access to local transport As for Health Centre As for Dispensary plus.

- Provision of boat and / or vehicle for link to Health Centre and provision of outreach services.
As for Remote Dispensary plus - Access to wharf, landing zone or airfield utilising common modes of transport.
94 PROVINCIAL HOSPITALS Service/Function Functional requirements Area (m2) Notes APPENDIX D2: HOSPITAL FUNCTIONAL SPACE AND UTILITIES OUTPATIENT SERVICES Emergency Department (ED) Waiting area (internal) Reception/registration and triage point Resuscitation bay Acute treatment bay/cubicle Consultation/examination room Dressing/plaster/procedure room Observation/holding bed(s) Psychiatric emergency room – secure, padded Mobile equipment bay Staff station Store room/clean utility/ file storage Dirty utility/sluice Staff tea/meeting room Disaster kit storage Toilets – patient (male & female) Toilet – staff General Outpatients Department (GOPD) Waiting area (internal and external) with health promotion area.
Reception and triage point Consultation/examination rooms Eye/ear room Small area adjacent to GOPD waiting Shared with GOPD 2 beds.

Direct external access desirable Includes nebuliser station(s).

Number of bays depends on activity level – refer standards May be shared with GOPD 15 9 25 4 12 14 8-12 1-2 beds depending on demand 9 4 8 8 8 16 4 2 x 3 4 15 -30 12 16 Shared with GOPD Shared with GOPD May be shared with GOPD?
Shared with GOPD Shared with GOPD Secure store room, with locked external access With handwashing.

Shared with GOPD With handwashing.

Shared with GOPD Internal area may be shared with ED.

Covered external area, with seating for up to 40 people, depending on demand.

Shared with ED Number depends on activity – refer standards.

May be shared with ED.

Soundproof room; able to be darkened, with space for equipment storage plus write-up area for Eye & ENT nurses.
95 Service/Function Functional requirements Area (m2) Notes Treatment room Observation bed(s) Store room/clean utility/file storage Dirty utility Toilets – patient (male & female) Toilet – staff Waiting area Consultation/examination rooms Specialist outpatient clinics 16 10 16 12 Includes areas for dressings, injections, nebuliser treatment.
Shared with ED May be shared with ED Shared with ED Shared with ED Shared with ED May be shared with GOPD Number depends on activity level – refer standards Paediatric/child health clinics Waiting area with reception desk and triage station 20-30 Space depends on activity.

Has health promotion area with TV Consultation/examination room Treatment room 12 16 Includes resuscitation bay with trolley.
Observation area – 1-2 beds 8 per bed Size depends on activity level Store room/clean utility/file storage 10 May be shared with other clinic services Dirty utility Toilets – patient Toilet – staff NCD Hub Waiting area with reception desk Consultation cubicles x 2: NCD nurse; dietitian/nutrition nurse 6 per cubicle May be shared with other clinic services May be shared with other clinic services May be shared with other clinic services Space depends on patient numbers: allow 0.5 m2 per person Consult room: doctor/NP Eye assessment room Footcare room Handwashing bay Staff toilets & lockers Toilets – patient (male & female) Store 10 8 12 2 8 2 x 3 6 With handwashing Able to be darkened With handwashing May be shared with SOPD With handwashing.
96 Service/Function Functional requirements Area (m2) Notes Antenatal clinic Waiting area with nurse station, scales 20-40 Seating for 15-40 women.

Area size depends on demand.

Has access to patient toilet and handwashing.

External overflow waiting area may be provided to accommodate families.
Screened examination bay(s) 3 per bay 1-2 bays depending on demand Consultation/examination room with CTG Women’s health clinic Waiting area with nurse station Screened examination bay Dental services Consultation/examination/procedure room Reception and waiting area with oral health promotion area Dental surgery with space for at least 1 chair, with lights, drill and suction units.

Sterilising bay with bench, sink and autoclave plus storage for sterile supplies.
Office area for dental officer Storage area for dental equipment and records, Store for compressor (external) 12 16 3 14 10 12 6 9 8 4 Space for desk, couch, CTG machine, handwashing.

May be shared with SOPD Space for up to 10 people with access to toilet and handwashing Requires suitable plumbing & drainage Compressor to be housed close by but outside dental surgery.
Health promotion programs Room/space for staff conducting health promotion activities/programs in hospital INPATIENT SERVICES 30 Ideally located within or adjacent to GOPD waiting area.

General/Medical/Sur gical wards Male and female ward, each including a 2-bed acute care area, adjacent to staff station.

1 bed room – 12 Bed numbers are to be determined separately at each site, based on utilisation.

Isolation Ward TB Ward 2 bed ward adjacent to general ward.

Each must have separate toilet and shower.


Hand washing bay just outside the door.

Air-conditioning should be negative pressure Separate self-contained building.

NB fewer beds required as treatment shifts to community.

2 bed room – 20 4 bed room - 32 Antenatal and Located adjacent to each other to allow flexible Beds are arranged in 4 bed bays, plus a number of single rooms with ensuite shower and toilet, suitable for private use or infection control.
All wards to include (size m2 in brackets)  Staff station (9)  Office for In charge (9)  Hand washing bay (1): one per 6 beds 97 Service/Function Functional requirements Area (m2) Notes Postnatal ward use.

Includes baby care room for bathing, feeding, examinations etc plus area for post- operative patients close to staff station.

Nursery Accommodates humidicribs(s), cots, plus space for breastfeeding and storage.
7 per cot Examination/bathing area Phototherapy bay Paediatric ward Hand hygiene bay – wash basin and alcohol rub Paediatric ward, including area suitable for isolation of infectious cases.
Acute care bay (1-2 beds) Children’s play area Bathroom with bath Birthing Screened cubicle/room for assessment/prep/CTG 6 2 1 10 - 16 16 10 8  Ready access to resuscitation trolley  Access to shower and toilet facilities  Interview/consultation room (9)  Ward pharmacy cupboard (1)  Linen bay (1)  Clean utility/storage (10)  Dirty utility with sluice (8)  Access to staff tea room, toilets and changing room  Access to meeting room  Access to visitor waiting area Some of these facilities may be shared among two or more wards, depending on the size and proximity of those wards.
All inpatient areas require good ventilation & insect screens.

Located near entrance to labour ward.

Labour/first stage ward (2-4 beds) with ambulation area 10 per bed 2 labour ward beds per delivery bed.

Bed numbers need to be determined separately at each site.

Delivery room (1-2 beds) High dependency area (1 bed) Sterile stock room Pharmacy imprest bay/cupboard Staff change room, toilet and handwashing Waiting area for families 16 per bed High dependency bed located adjacent to delivery room.
10 6 2 8 16 ALLIED HEALTH/CLINICAL SUPPORT SERVICES Pharmacy Waiting area 12-20 May be shared with outpatients Work area with benches/tables for assembly/preparation/checking of medications.

Pharmacy store with shelving, refrigerated storage and receiving area for deliveries.

12 10 Pharmacy area must be secure, temperature controlled, with space for bulk fluids and vaccine fridge.

Direct access to delivery dock is desirable.


98 Service/Function Functional requirements Area (m2) Notes Dangerous drugs cupboard Dispensing/drug information area window.
Pharmacist office Secondary/bulk store Medical laboratory Reception and waiting area Collection room with adjacent toilet Specimen reception and storage area Haematology & biochemistry area Microbiology area Media preparation bay with sink, workbench and storage Wash bay with steriliser Technician’s office Interview/counselling room Storage for equipment, reagents etc Tea room Blood bank Collection room with donation couch and blood storage fridge.
Donor refreshment area Medical Imaging Reception and waiting area Patient change area (2 cubicles) General X-ray room Ultrasound scanning room Processing room and chemical store Reporting area with technician’s office space File storage area 2 2 9 14 10 6 + 3 2 16 12 6 4 9 9 16 16 10 10 10 8 20 8 8 12 4 Directly accessible from waiting area.

Space for storage & distribution of bulk fluids and supplies to provincial health facilities.
Space for up to 10 people, depending on size of hospital Phlebotomy chair/couch ‘Clean’ and ‘dirty’ laboratory functions require separate work areas, each with benches and sinks.

Must be dry, cool Shared with other allied health services Waiting area shared with laboratory.

Blood storage fridge within laboratory storage area.
Space for 6-10 people, depending on size of hospital Needs easy access to patient toilet Requires shielding Only required if plain film system in use Only required if plain film system in use 99 Service/Function Functional requirements Operating Theatre Anteroom/receiving area Scrub area Operating room Procedure room Recovery area (2 bays) Change room, toilet and shower Sterile stock room with packing area Store: non-sterile supplies Anaesthetics Office space for anaesthetist, theatre manager Storage for anaesthetic machines & equipment.
Sterilising (CSSD) & Infection Control Receiving bay Instrument rinsing/disinfecting area Instrument sorting, packing area Autoclave area Despatch area Storage for sterile equipment & linen General store (chemicals etc) Trolley stripping, wash bay Change room with toilet and shower Workshop area with work benches and secure storage for equipment and tools Storage area for equipment awaiting repair.
Technician’s office with computer Biomedical Physiotherapy/Reha b Gym area with space for 1-2 treatment cubicles and large open area for exercise programs.

Assessment/consult/treatment room Office for OIC, with file storage area.

Area (m2) Notes 8 6 30 16 16 12 20 10 12 8 6 12 14 12 4 10 4 8 12 50 10 10 Theatres located together with direct access from A&E and Labour Ward.

Adjacent to theatres Trolley access necessary.


Sterilising unit should allow a one-way progression of instruments from ‘dirty’ to ‘clean’.

May be shared with theatres Allow for storage of bulky equipment Must be wheelchair accessible.

Located to be accessible from both inpatient and outpatient areas 100 Service/Function Functional requirements Area (m2) Notes Medical records/health information Small ADL kitchen Bulky equipment store.

Shower – accessible Accessible/assisted toilet and handwashing.
Receiving area with window Record assembly/sorting and work table File storage shelving (active) Office/computer station for HIS officer Trolley holding bay Archive storage MANAGEMENT/ADMINISTRATION/EDUCATION Administrative offices Offices for Medical Superintendent Manager Nursing Manager General Services Administrative staff Doctors (shared) Small meeting room To seat up to 8 people Large meeting room To seat 20 people Library Conference/training room Staff amenities Shelving for publications, reading area and computer station with internet access To seat up to 40 people Common/dining room with tea making facilities.
Male and female staff change areas with shower, toilets and lockers.

On call accommodation On call rooms for medical, nursing, medical imaging and laboratory staff 12 20 6 4 8 10 20 9 6 20 16 24 16 36 May be shared with wards Located near outpatient reception desk.

Includes desk for filing clerk.
May be compactus if space is limited and structure permits Needs to be specified at each site Shared with Public Health: capacity to be specified at each site 101 Service/Function Functional requirements Area (m2) Notes GENERAL SUPPORT SERVICES Kitchen/food service Office for head cook Food preparation area Cooking area Store for cooking equipment and crockery Cooked food storage area Food storage (dry, fresh and refrigerated goods) Dishwashing area Trolley holding bay Bin area for hygienic disposal of kitchen waste.
Office for housekeeping supervisor Receiving area for soiled linen Area for washing machines and dryers Linen folding and sewing area Clean linen storage.

Outside area for line drying Housekeeping supervisor Laundry Cleaning Transport and parking Storeroom for cleaning equipment and supplies Covered parking space to store 3 vehicles.

Workshop with pit for maintenance of vehicles.

General storage area for fuel etc.

Mortuary Body preparation and viewing area Refrigerated storage drawers for 2-6 bodies.
Relatives waiting/gathering area Maintenance Office – maintenance supervisor Workshop - general Store – general 9 16 20 4 6 24 10 10 4 9 3 12 9 3 30 6 10 4 25 9 40 30 Include space for dietitian?

Located outside but adjacent to kitchen.

Located close to laundry and cleaning store.

May be partially covered.

Located adjacent to supervisor’s office Room should be temperature controlled and have direct access from outside for ambulance and funeral vehicles.

External, covered area adjacent to viewing area.


102 Service/Function Functional requirements Area (m2) Notes Groundsman’s store Bulky equipment storage Protected area suitable for storage of spare beds, trolleys, wheelchairs, etc.

Waste management Rubbish collection point and bin storage.

Oxygen store Hostels / Accommodation Secure holding for surgical waste, sharps containers and expired medications.
Incinerator Sewage treatment plant Staff Accommodation – 3 Bedroom Staff Accommodation – 2 Bedroom Staff Accommodation - Dormitory Maternity waiting or referral waiting accommodation 20 40 20 20 6 40 TBD 74 65 12 45 High temperature incineration system for medical and general waste, including glass, sharps & combustible biohazard material.
Dependant on capacity requirement Doctors, Senior Nurses, Allied Health workers and Senior Administration with families Managers, Nurses, allied health workers with families Per dormitory bedroom with access to shared ablutions Per unit with ablution access Where provincial health administration is based at the hospital, additional office space will be required for Provincial Administrator; Public Health program coordinators and possibly others.
Actual office space requirements are to be determined on a site by site basis 103 REGIONAL REFERRAL HOSPITALS Service/Function Functional requirements Area (m2) Notes OUTPATIENT SERVICES Emergency Department (ED) Waiting area Reception and triage area Resuscitation area (2 bays) Acute treatment bay/cubicle Consultation/examination room Dressing/plaster/procedure room Observation/holding bed(s) Psychiatric emergency room – secure, padded Mobile equipment bay Linen bay General store Staff station Clean utility Dirty utility/sluice Handwashing bay Staff tea/meeting room Disaster kit storage Toilets – patient (male & female) Staff toilet & lockers Ambulance bay (external) General Outpatients Department (GOPD) Waiting area (covered) with health promotion area.
20 12 36 Adjacent to GOPD waiting.

Space for up to 20 people.

May be shared with GOPD 2 beds.

Direct external access desirable 8 per bay Includes nebuliser station(s).

Mix of beds and chairs.

Number of bays depends on activity level – refer to standards May be shared with GOPD 12 14 16-32 2-4 beds depending on demand – refer to standards 9 4 1 8 10 12 10 1 16 6 2 x 3 8 40 May be shared with GOPD May be shared with GOPD Shared with GOPD Secure store room, with locked external access With handwashing.
Shared with GOPD With handwashing.

Shared with GOPD Covered area for patients to be transferred from ambulance to ED.

Area may be shared with ED.

Covered external area, with seating for up to 60 people, depending on demand.

104 Service/Function Functional requirements Area (m2) Notes Reception and triage point Consultation/examination rooms Treatment room Observation bed(s) Store room/clean utility Dirty utility 12 12 16 May be shared with ED Number of rooms depends on activity – refer standards.
Includes areas for dressings, injections, nebuliser treatment.
16-32 Shared with ED 12 10 May be shared with ED Shared with ED Toilets – patient (male & female) 2 x 3 Shared with ED Specialist outpatient clinics Staff toilet & lockers Waiting area Consultation/examination rooms Treatment/procedure room Eye room ENT room Staff toilets & lockers 8 16 12 14 12 12 8 Shared with ED Number depends on activity level – refer to standards Soundproof room; able to be darkened, with space for equipment storage plus write-up area for Eye nurses.
Space for equipment storage plus write-up area for ENT nurses.

May be shared with Women’s Health Toilets – patient (male & female) 2 x 3 With handwashing.

Paediatric clinic Waiting area with reception desk Triage station Consultation/examination rooms Treatment room 30 6 12 16 Space depends on activity.

Has health promotion area with TV Space for triage nurse, seating for up to 3 people Number depends on activity – refer standards.

Includes resuscitation bay with trolley.
Observation area – 1-2 beds 8 per bed Size depends on activity level Store room/clean utility/file storage Dirty utility Office - shared Toilets – patient Staff toilets & lockers 10 8 12 6 8 NCD Hub Waiting area with reception desk May be shared with other clinic services May be shared with other clinic services May be shared with other clinic services May be shared with other clinic services Space depends on patient numbers: allow 0.5 m2 per person 105 Service/Function Functional requirements Area (m2) Notes Consultation cubicles x 2: NCD nurse; dietitian 6 per cubicle Consult room: doctor/NP Eye assessment room Footcare room Handwashing bay Staff toilets & lockers 10 8 12 2 8 With handwashing Able to be darkened With handwashing May be shared with SOPD Toilets – patient (male & female) 2 x 3 With handwashing.
Antenatal clinic Waiting area with nurse station, scales Store 6 50 Seating for up to 60 women.

Area size depends on demand.

Has access to patient toilet and handwashing.

External overflow waiting area may be provided to accommodate families.
Screened examination bay(s) Toilets – patient (2 cubicles) Staff toilets & lockers Consultation/examination room with CTG Women’s health clinic Waiting/reception area Consultation/examination room Nursing station with file storage Mental health outpatients Clean utility Staff toilets & lockers Toilets – patient Waiting area Consultation room Day therapy area Store (equipment) Drug cabinet (secure) 3 per bay 2-4 bays depending on demand 6 8 12 16 12 9-12 8 8 With handwashing.
May be shared with Women’s Health Space for desk, couch, CTG machine, handwashing.

Number depends on activity level – refer standards Includes storage for equipment, medical supplies & drugs.

May be shared with Antenatal or SOPD 2 x 3 May be shared with SOPD 12 10 40 6 1 Open area for individual and group activities with kitchenette, access to external courtyard and patient toilets.
106 Service/Function Functional requirements Area (m2) Notes Dental services Office (shared) Reception and waiting area with oral health promotion area Storage area for dental equipment and records 12 20 8 Space for up to 20 people with access to toilet and handwashing.

Capacity depends on activity level – refer standards Located near reception area Dental surgery with space for at least 1 chair, with lights, drill and suction units.

14 per chair Area depends on activity level – refer standards.
Requires suitable plumbing & drainage X-ray room Dark room for X-ray processing Sterilising bay with bench, sink and autoclave plus storage for sterile supplies.
Dental laboratory Laboratory store Office for HOD Office area for dental staff Staff tea room/meeting room Toilets – patient Staff toilet and lockers Store for compressor (external) Health promotion programs Room/space for staff conducting health promotion activities/programs in hospital INPATIENT SERVICES 8 4 10 12 6 9 9 16 2 x 3 8 4 30 Shielded Not required if digital system in place.

May be shared with SOPD Compressor to be housed close by but outside dental surgery.
Ideally located within or adjacent to GOPD waiting area.

General / Medical / Surgical wards Male and female ward, each including a 2-bed acute care area, adjacent to staff station.

1 bed room – 14 Bed numbers are to be determined separately at each site, based on utilisation.

Isolation Ward 2 bed ward adjacent to medical ward.

Each has ensuite toilet and shower.

Hand washing bay just outside the door.


Air-conditioning should be negative pressure 2 bed room – 22 4 bed room - 40 TB Ward Separate self-contained building.

NB fewer beds Beds are arranged in 4 bed bays, plus 2 single rooms with ensuite shower and toilet, suitable for private use or infection control.
All wards to include (size m2 in brackets) Staff station & write up area (12 m2)  107 Service/Function Functional requirements Area (m2) Antenatal and Postnatal ward Nursery required as treatment shifts to community.

Located adjacent to each other to allow flexible use.

Includes baby care room for bathing, feeding, examinations etc plus area for post- operative patients close to staff station.

Accommodates humidicribs and cots, plus space for breastfeeding and storage.
Ideally located between maternity and paediatric wards.

7 per cot Examination/bathing area Phototherapy bay Staff change and property bay Paediatric ward Paediatric ward, including area suitable for isolation of infectious cases.

High dependency area – 2 beds Children’s play area Bathroom with bath Psychiatric admission unit 4 bed ward with one seclusion room for acutely unwell patients.

Located adjacent to but separate from medical ward.
6 2 4 16 16 12 Notes  Office HOD (9 m2)  Office, Nurse in Charge (9 m2) Treatment/consultation room (14 m2)   Access to interview/counselling room (9 m2)  Hand washing bay (1 per 6 beds: 1 m2).
 Ready access to resuscitation trolley  Access to patient shower and toilet facilities (1 toilet & shower per 4 beds: toilet 3 m2, shower 4m2)  Accessible toilet (4 m2)  Ward pharmacy cupboard (1 m2) Linen bay (1 m2)  Clean utility/storage (10 m2)   Dirty utility with sluice (8 m2)  General store (6 m2) Equipment store (12 m2)  Staff tea room (16m2)   Access to visitor waiting area Some of these facilities may be shared among two or more wards, depending on the size and proximity of those wards.
All inpatient areas require good ventilation & insect screens.

Birthing Assessment/prep/CTG room 14 Located near entrance to labour ward.

Labour ward/first stage room (8 places) with ambulation area Delivery room (4 beds) High dependency area (1 bed) Sterile stock room Equipment store 10 per bed 16 per bed 2 labour ward places per delivery bed.

Bed numbers need to be determined separately at each site.

Labour ward includes a mix of beds and chairs.

High dependency bed located adjacent to labour ward.
Handwashing units inside 14 8 12 108 Service/Function Functional requirements Area (m2) Notes Pharmacy imprest bay/cupboard Resuscitation trolley bay Linen trolley bay Staff station Office – Charge Midwife Clean utility Dirty utility/sluice Staff change room, toilet and handwashing Waiting area for families ALLIED HEALTH/CLINICAL SUPPORT SERVICES Pharmacy Waiting area Work area for assembly/preparation/checking of inpatient medications.
Work area for assembly/preparation/checking of outpatient medications Pharmacy store with shelving, refrigerated storage and receiving area for deliveries.

Dangerous drugs store Dispensing/drug information area window.

Drug education/counselling room Pharmacist office Goods receiving area Staff toilet & lockers Secondary/bulk store Medical laboratory Reception and waiting area 2 1 1 12 9 10 8 8 20 30 12 16 10 3 2 8 9 4 8 40 16 Covered area, with seating and good ventilation.
May be shared with outpatients.

Pharmacy area must be secure, temperature controlled, with space for bulk fluids and vaccine fridge.

Direct access to delivery dock is desirable.

Work areas include work benches/tables plus shelving.

Directly accessible from waiting area.

May be shared with other Allied Health services May be located off site.
Space for storage & distribution of bulk fluids and supplies to provincial health facilities Space for up to 20 people, depending on size of hospital 109 Service/Function Functional requirements Area (m2) Notes Collection room with adjacent toilet 8 + 3 Phlebotomy chair/couch Counselling room Specimen reception and storage area Haematology & biochemistry area Microbiology/TB area Media preparation bay with sink and workbench Wash bay with steriliser Technician’s office Storage for equipment, reagents etc Staff tea/meeting room Staff toilet & lockers Blood bank Collection room with donation couch and blood storage fridge.
Medical Imaging Reception and waiting area Donor refreshment room Office – Chief Radiographer General X-ray room Ultrasound scanning room OPG room Fluoroscopy room with ensuite toilet Reporting area/office space Mobile equipment bay Patient change area (2 cubicles) Toilets – patient (male & female) General store PACS unit /File storage area Staff tea/meeting room 9 2 16 16 6 4 9 8 16 8 12 12 20 8 32 14 8 32 12 6 4 2 x 3 6 4 16 ‘Clean’ and ‘dirty’ laboratory functions require separate work areas, each with benches and sinks.
Must be cool, dry space May be shared with other Allied Health services Waiting area shared with laboratory.

Blood storage fridge within laboratory storage area.
Space for up to 20 people Requires shielding Requires shielding Requires shielding Needs easy access to patient toilet 110 Service/Function Functional requirements Area (m2) Notes High Dependency Unit (HDU) Operating Theatres & endoscopy Staff toilets & lockers Bed space (open) Isolation bay Staff station Mobile equipment bay Resuscitation trolley bay Clean utility Dirty utility Storeroom Office Patient shower & toilet Staff tea room/meeting room Staff change, toilet and property bay Waiting area Holding/anaesthetic bay Scrub/gowning area Operating room(s) Procedure/endoscopy room Recovery/transfer area (4 bays) Clean-up/flash sterilising area Sterile stock room with packing area Clean utility Dirty utility Change room, toilet and shower Mobile equipment store Store: non-sterile supplies Office: In Charge 8 32 12 10 8 2 10 8 10 9 8 16 6 20 8 6 40 per room 28 32 10 20 12 10 12 12 10 9 May be shared with ED or ward May be shared with ED or ward May be shared Theatres located together with direct access from A&E and Labour Ward.
Number of operating rooms dependent on level of demand – refer to standards 111 Service/Function Functional requirements Area (m2) Notes Doctors’ room Staff tea room/meeting room Change room and staff toilet - male Change room and staff toilet - female Anaesthetics Storage for anaesthetic machines & equipment.
Sterilising (CSSD) & Infection Control Anaesthetics office Receiving bay Instrument rinsing/disinfecting area Instrument sorting, packing area Autoclave area Despatch area Storage for sterile equipment & linen General store (chemicals etc) Trolley stripping, wash bay Change room with toilet and shower Biomedical General workshop area with work benches Physiotherapy / Rehab General store Storage area for biomedical equipment Chemical store?
Medical gases Technician’s office with computer Reception/clerical/ file storage area Gym area with space for 1-2 treatment cubicles and large open area for exercise programs.

Assessment/consult/treatment room Office for OIC Office for therapy staff 12 16 10 10 15 9 8 24 30 24 4 20 12 8 12 30 30 15 12 25 10 10 50 12 9 14 With desk and computer Adjacent to theatres Trolley access necessary.

Sterilising unit should allow a one-way progression of instruments from ‘dirty’ to ‘clean’.
May be shared with theatres secure storage for equipment and tools Allow for storage of bulky equipment Must be wheelchair accessible.

Located to be accessible from both inpatient and outpatient areas 112 Service/Function Functional requirements Area (m2) Notes ADL kitchen Meeting/education room General store Bulky equipment store.

Accessible/assisted toilet and handwashing Shower rooms – accessible, male & female Beverage pantry Staff toilet and property bay.
Receiving area with window Record assembly/sorting and work table Coding/clerical work space File storage shelving (active) Office/computer station for HIS officer Trolley holding bay Archive storage Medical records/health information MANAGEMENT/ADMINISTRATION/EDUCATION Administrative offices Offices for Medical Superintendent Manager Nursing Manager General Services IT support Administrative staff Doctors (shared) Small meeting room To seat up to 8 people Large meeting/tutorial room Library 10 25 12 20 4 2 x 5 4 4 8 10 6 40* 9 6 20 12 25 Staff tea room May be shared with wards?
Located near outpatient reception desk.

Includes desk for filing clerk.

Medical records storage.

May be compactus if space is limited and structure permits * Less space required if systems are fully digitised.
Needs to be specified at each site Office – Manager (15 m2) Office – other (9 m2) Office – admin/clerical, shared (30 m2) Office – medical officers, shared (30 m2) Shelving for publications, reading area and TBD 113 Service/Function Functional requirements Area (m2) Notes Conference/training room Staff amenities computer station with internet access To seat up to 50 people Common/dining room with tea making facilities.

Male and female staff change areas with shower, toilets and lockers.
40 TBD TBD On call accommodation On call rooms for medical, nursing, medical imaging and laboratory staff 12 Individual units with access to shared staff facility.

Dormitory style.
Dormitory style.

GENERAL SUPPORT SERVICES Housekeeping Supervisor Kitchen/food service Office for head cook and dietitian Office for housekeeping supervisor Food preparation area Cooking area Tray assembly area Store for cooking equipment and crockery Cooked food storage area Food storage (dry, fresh and refrigerated goods) Dishwashing area Trolley holding bay Laundry Receiving area for soiled linen Bin area for hygienic disposal of kitchen waste.
Area for washing machines and dryers Linen folding and sewing area Clean linen storage.

Outside area for line drying Cleaning Storeroom for cleaning equipment and supplies Transport and Covered parking space to store 3 vehicles.

9 10 16 20 15 4 6 30 10 10 4 15 20 12 30 30 6 Located near Laundry & cleaning store Located outside but adjacent to kitchen.

May be partially covered.


Located adjacent to kitchen area and supervisor’s office 114 Service/Function Functional requirements Area (m2) Notes parking Workshop with pit for maintenance of vehicles.

Mortuary Entry lobby/clerical General storage area for fuel etc.

Body preparation area Body viewing area Refrigerated storage drawers for 6-8 bodies.
Relatives waiting/gathering area Maintenance Office – maintenance supervisor Workshop – general Store – general Groundsman’s store Bulky equipment storage Protected area suitable for storage of spare beds, trolleys, wheelchairs, etc.

Oxygen store Staff Amenities Staff dining room/cafeteria Staff showers and change rooms Waste management Rubbish collection point and bin storage.

Secure holding for surgical waste, sharps containers and expired medications.
Incinerator Hostels / accommodation Sewage treatment plant TBD Staff Accommodation – 3 Bedroom Staff Accommodation – 2 Bedroom Staff Accommodation - Dormitory Maternity waiting or referral waiting accommodation 6 6 8 12 25 10 40 50 20 40 20 TBD TBD 20 6 40 74 65 12 45 Room should be temperature controlled and have direct access from outside for ambulance and funeral vehicles.

Freezer provision?

External, covered area adjacent to viewing area.


High temperature incineration system for medical and general waste, including glass, sharps & combustible biohazard material.
Dependent on capacity waste flows Doctors, Senior Nurses, Allied Health workers and Senior Administration with families Managers, Nurses, allied health workers with families Per dormitory bedroom with access to shared ablutions Per unit with ablution access 115 116 NATIONAL REFERRAL HOSPITAL Service/Function Functional requirements Area (m2) Notes OUTPATIENT SERVICES Emergency Department (ED) Waiting area Reception and triage area Resuscitation area (2 bays) 30 12 36 Adjacent to GOPD waiting.
Space for up to 30 people.

2 beds.

Direct external access desirable Acute treatment bay/cubicle 8 per bay Includes nebuliser station(s).

Mix of beds and chairs.
Number of bays depends on activity level – refer to standards Consultation/examination room Dressing/plaster/procedure room 12 14 Observation/holding bed(s) 16-32 2-4 beds depending on demand – refer to standards Psychiatric emergency room – secure, padded Mobile equipment bay Linen bay General store Staff station Clean utility Dirty utility/sluice Handwashing bay Meeting room Staff tea room Disaster kit storage 9 4 1 8 10 12 10 1 16 12 6 Secure store room, with locked external access Toilets – patient (male & female) 2 x 3 With handwashing.
117 Service/Function Functional requirements Area (m2) Notes Staff toilet & lockers 8 With handwashing.

May be shared with GOPD Ambulance bay (external) Covered area for patients to be transferred from ambulance to ED.

General Outpatients Department (GOPD) Waiting area (covered) with health promotion area.

40 Covered area, with seating for up to 80 people, depending on demand.
Staff station Reception and triage point Consultation/examination rooms Treatment room Observation bed(s) Store room/clean utility Dirty utility Toilets – patient (male & female) Staff toilet & lockers Specialist outpatient clinics Waiting area Staff station Consultation/examination rooms Treatment/procedure room Store room/clean utility Dirty utility 10 12 12 16 16-32 12 10 2 x 3 8 16 10 12 14 12 10 Number of rooms depends on activity – refer standards.
Includes areas for dressings, injections, nebuliser treatment.

Number depends on activity level – refer to standards 118 Service/Function Functional requirements Area (m2) Notes Staff toilets & lockers 8 Toilets – patient (male & female) 2 x 3 With handwashing.
Eye Clinic Waiting area Consultation room Treatment/procedure room Office – Eye nurses (shared) Office - Ophthalmologist Store room/clean utility Dirty utility Meeting/tutorial room Beverage pantry/kitchenette Staff toilets & lockers 16 12 16 12 9 12 10 16 4 8 Number depends on activity level – refer to standards May be shared with ENT & Dental May be shared with ENT & Dental May be shared with ENT & Dental Toilets – patient (male & female) 2 x 3 Shared with ENT & Dental ENT Clinic Waiting area Consultation room Audiometry room Laboratory Office – ENT nurses (shared) Office – ENT specialist Store room/clean utility Dirty utility Meeting/tutorial room Beverage pantry/kitchenette 20 12 12 10 12 9 12 10 16 4 Number depends on activity level – refer to standards Sound proof For ear impressions and mould manufacture May be shared with Eye & Dental May be shared with Eye & Dental 119 Service/Function Functional requirements Area (m2) Notes Staff toilets & lockers Paediatric clinic Waiting area with reception desk Triage station Consultation/examination rooms Treatment room 8 30 6 12 16 May be shared with Eye & Dental Space depends on activity.
Has health promotion area with TV Space for triage nurse, seating for up to 3 people Number depends on activity – refer standards.

Includes resuscitation bay with trolley.
Observation area – 2-4 beds 8 per bed Size depends on activity level Store room/clean utility/file storage Dirty utility Office – paediatrician Office – paediatric nurses Meeting/tutorial room Toilets – patient Staff toilets & lockers 10 8 9 12 16 6 8 NCD Hub Waiting area with reception desk and health promotion area Consultation cubicles x 2: NCD nurse; dietitian 6 per cubicle May be shared with other clinic services May be shared with other clinic services May be shared with other clinic services Space depends on patient numbers: allow 0.5 m2 per person Consult room: doctor/NP Eye assessment room Footcare room Handwashing bay Meeting/tutorial room Beverage pantry/kitchenette Staff toilets & lockers 10 8 12 2 16 4 8 With handwashing Able to be darkened With handwashing May be shared with SOPD May be shared with SOPD 120 Service/Function Functional requirements Area (m2) Notes Toilets – patient (male & female) 2 x 3 With handwashing.
Store Antenatal clinic Waiting area with nurse station, scales 6 50 Seating for up to 60 women.

Area size depends on demand.

Has access to patient toilet and handwashing.

External overflow waiting area may be provided to accommodate families.
Screened examination bay(s) Toilets – patient (2 cubicles) Staff toilets & lockers Consultation/examination room with CTG Women’s health clinic Waiting/reception area Consultation/examination room Nursing station with file storage Mental health outpatients Clean utility Staff toilets & lockers Toilets – patient Waiting area Consultation room Day therapy area Store (equipment) Drug cabinet (secure) Office – Psychiatrist 3 per bay 4-6 bays depending on demand 6 8 12 16 12 9-12 8 8 With handwashing.
May be shared with Women’s Health Space for desk, couch, CTG machine, handwashing.

Number depends on activity level – refer standards Includes storage for equipment, medical supplies & drugs.

May be shared with Antenatal or SOPD 2 x 3 May be shared with SOPD 12 10 40 6 1 9 Open area for individual and group activities with kitchenette, access to external courtyard and patient toilets.
121 Service/Function Functional requirements Area (m2) Notes Office – nursing (shared) 12 Dental services Reception and waiting area with oral health promotion area Space for up to 40 people with access to toilet and handwashing.

Capacity depends on activity level – refer standards Storage area for dental equipment and records 8 Located near reception area Dental surgery with space for at least 4 chairs, with lights, drill and suction units.

14 per chair Area depends on activity level – refer standards.
Requires suitable plumbing & drainage X-ray room Dark room for X-ray processing Sterilising bay with bench, sink and autoclave plus storage for sterile supplies.
Dental laboratory Laboratory store General store Office for HOD Office area for dental staff Staff tea room/meeting room Toilets – patient Staff toilet, change and lockers Store for compressor (external) Health promotion programs Room/space for staff conducting health promotion activities/programs in hospital INPATIENT SERVICES 8 4 10 12 6 8 9 9 16 2 x 3 10 4 30 Shielded Not required if digital system in place.

May be shared with SOPD Compressor to be housed close by but outside dental surgery.
Ideally located within or adjacent to GOPD waiting area.

General / Medical / Male and female ward, each including a 2-bed 1 bed room – Bed numbers are to be determined separately at each site, based on 122 Service/Function Functional requirements Area (m2) Notes Surgical wards acute care area, adjacent to staff station.

14 utilisation.

Isolation Ward TB Ward Antenatal and Postnatal ward 2 bed ward adjacent to medical ward.

Each has ensuite toilet and shower.

Hand washing bay just outside the door.


Air-conditioning should be negative pressure 2 bed room – 22 4 bed room - 40 Separate self-contained building.

NB fewer beds required as treatment shifts to community.

Located adjacent to each other to allow flexible use.

Includes baby care room for bathing, feeding, examinations etc plus area for post- operative patients close to staff station.

Antenatal day assessment unit Located adjacent to antenatal ward.
Separate area with 2 beds with CTG and ultrasound access.

Nursery Accommodates humidicribs and cots, plus space for breastfeeding and storage.

Ideally located between maternity and paediatric wards.

7 per cot Examination/bathing area Phototherapy bay Staff change and property bay Paediatric ward Paediatric ward, including area suitable for isolation of infectious cases.
High dependency area – 2 beds Children’s play area Bathroom with bath 6 2 4 16 16 12 Beds are arranged in 4 bed bays, plus 2 single rooms with ensuite shower and toilet, suitable for private use or infection control.

All wards to include (size m2 in brackets) Staff station & write up area (12 m2)   Office HOD (9 m2)  Office, Nurse in Charge (9 m2) Treatment/consultation room (14 m2)   Access to interview/counselling room (9 m2)  Hand washing bay (1 per 6 beds: 1 m2).
 Ready access to resuscitation trolley  Access to patient shower and toilet facilities (1 toilet & shower per 4 beds: toilet 3 m2, shower 4m2)  Accessible toilet (4 m2)  Ward pharmacy cupboard (1 m2) Linen bay (1 m2)  Clean utility/storage (10 m2)   Dirty utility with sluice (8 m2)  General store (6 m2) Equipment store (12 m2)  Staff tea room (16m2)   Access to visitor waiting area Some of these facilities may be shared among two or more wards, depending on the size and proximity of those wards.
All wards require access to meeting/tutorial rooms: generally shared between 2-3 wards, depending on unit size and staff numbers.

All inpatient areas require good ventilation & insect screens.

123 Service/Function Functional requirements Area (m2) Notes Psychiatric admission unit Rehabilitation unit Freestanding ward with up to 12 beds, including one seclusion room for acutely unwell patients.

Located with psychiatric outpatients/day therapy area in close proximity to medical ward.
Freestanding unit of 12 beds with additional space to allow for mobility aids and wheelchair accessible.

Ideally located with rehabilitation outpatients with access to therapy areas.

Birthing Assessment/prep/CTG room 14 Located near entrance to labour ward.
Labour ward/first stage room (8 places) with ambulation area Delivery room (4 beds) High dependency area (MICU - 1 bed) Sterile stock room Equipment store Handwashing bay Pharmacy imprest bay/cupboard Resuscitation trolley bay Linen trolley bay Staff station Office – medical officer Office – Charge Midwife Clean utility Staff tea room Dirty utility/sluice 2 labour ward places per delivery bed.

Bed numbers need to be determined separately at each site.

Labour ward includes a mix of beds and chairs.


High dependency bed located adjacent to labour ward.

10 per bed 16 per bed 14 8 12 6 x 1 In labour ward, all delivery rooms and MICU area 2 1 1 12 9 9 10 10 8 124 Service/Function Functional requirements Area (m2) Notes Staff change room, toilet and handwashing Waiting area for families ALLIED HEALTH/CLINICAL SUPPORT SERVICES Pharmacy Waiting area Work area for assembly/preparation/checking of inpatient medications.
Work area for assembly/preparation/checking of outpatient medications Sterile preparation/handling area (includes cytotoxics), with airlock + anteroom for scrubbing & gowning.

Pharmacy store with shelving, refrigerated storage and receiving area for deliveries.

Dangerous drugs store Dispensing/drug information area window.
Drug education/counselling room Chief Pharmacist office Pharmacist work station Meeting/tutorial room Staff tea room Goods receiving area Staff toilet & lockers Secondary/bulk store 8 20 30 12 16 15 16 3 2 8 9 5.5 16 10 4 8 40 Covered area, with seating and good ventilation.

May be shared with outpatients.

Pharmacy area must be secure, temperature controlled, with space for bulk fluids and vaccine fridge.

Direct access to delivery dock is desirable.

Work areas include work benches/tables plus shelving.
Directly accessible from waiting area.

May be shared with other Allied Health services May be located off site.
Space for storage & distribution of bulk fluids 125 Service/Function Functional requirements Area (m2) Notes Medical laboratory Reception and waiting area Collection room with adjacent toilet Counselling room Specimen reception and storage area Haematology area Haematology store Biochemistry area Microbiology/Serology area Anatomical pathology area: Media preparation bay with sink and workbench Wash bay with steriliser Technician’s office Storage for equipment, reagents etc Staff tea room Meeting/tutorial room Staff toilets & lockers Blood bank Collection room with donation couch Blood storage fridge & freezer.
and supplies to provincial health facilities 16 8 + 3 Space for up to 20 people, depending on size of hospital Phlebotomy chair/couch 9 2 16 8 16 16 20 6 4 9 8 10 16 8 12 6 Includes areas for high volume analysis, manual tests and lab work stations (microscopy).

Includes areas for high volume analysis and lab work stations (chemistry) plus equipment storage bay.
Separate enclosed area with negative pressure air conditioning includes Cytology lab; Histology lab; lab workstations, tissue processing and storage (samples, slides, specimens) Must be cool, dry space May be shared with other Allied Health services Waiting area shared with laboratory.

Blood storage fridge within laboratory storage area.

126 Service/Function Functional requirements Area (m2) Notes After hours blood store?
Donor refreshment room Medical Imaging Reception and waiting area Office – Chief Radiographer General X-ray room x 2 Ultrasound scanning room x 2 CT scanning room CT scanning control room CT computer equipment room Patient holding bay Resuscitation trolley bay OPG room Fluoroscopy room with ensuite toilet Reporting area/work stations Mobile equipment bay Patient change area (2 cubicles) Toilets – patient (male & female) General store 2 12 20 9 32 14 42 12 6 8 1.5 7 32 12 6 4 2 x 3 6 Space for up to 30 people Requires shielding.
Number of rooms depends on activity levels Number of rooms depends on activity levels Requires shielding Requires shielding Needs easy access to patient toilet 127 Service/Function Functional requirements Area (m2) Notes PACS unit /File storage area Staff tea room Linen bay Meeting/tutorial room 4 10 2 16 Patient change cubicles 4 x 1.5 May be shared with other clinical support services Staff toilets & lockers Intensive Care Unit (ICU) Waiting area Anteroom/gowning area Interview/counselling room Bed space (open) Isolation bay 8 15 2 12 16 per bed Bed numbers based on demand: possibly 4 – 6?
20 Enclosed, with air lock, ensuite bathroom and negative pressure air conditioning for infectious patients High dependency bed spaces 12 per bed Bed numbers equivalent to intensive care Bathrooms – patient Staff station Mobile equipment bay Resuscitation trolley bay 2 x 6 Size for 'full assistance', i.e.
2 staff plus equipment 10 Centrally located with a view of all beds 8 2 128 Service/Function Functional requirements Hand washing bay Clean utility Dirty utility Storeroom Office – Charge nurse Office – Medical Officer Staff tea room/meeting room Area (m2) 3 x 1 Notes At entry to the Unit, outside isolation room and in corridors May be shared with ED or ward 10 8 10 9 9 16 Staff change, toilet and property bay 2 x 6 Operating Theatres & endoscopy Waiting area Reception/clerical area Patient holding bay Scrub/gowning area Anaesthetic induction area: per theatre Operating room Procedure/endoscopy room 20 8 10 8 12 40 28 May be shared space or individual rooms Theatres located together with direct access from A&E and Labour Ward.
Number of operating rooms dependent on level of demand – refer to standards Recovery/transfer area 9 per bay 2 bays per theatre Clean-up/flash sterilising area 10 129 Service/Function Functional requirements Area (m2) Notes Sterile stock room with packing area Emergency resuscitation trolley bay Handwashing bay Mobile equipment store Store: non-sterile supplies Clean utility Dirty utility Office: In Charge Doctors’ room Meeting/tutorial room Staff tea room Change room and staff toilet - male Change room and staff toilet - female Staff toilet Anaesthetics Anaesthetics office Storage for anaesthetic machines & equipment Anaesthetics work room 20 2 1 12 10 12 10 9 12 16 10 10 10 3 12 15 10 With desk and computer With handwashing: separate to change room facilities Anaesthetics area located adjacent to theatres 130 Service/Function Functional requirements Area (m2) Notes Sterilising (CSSD) & Infection Control Reception Trolley stripping, wash bay Receiving area – used instruments Goods receiving – non-sterile stock Cleaning/decontamination Instrument sorting, packing area Autoclave area Cooling area Office – In charge + Infection Control Despatch area Storage for sterile equipment & linen General store (chemicals etc) Staff tea/meeting room Change room with toilet and shower Biomedical General workshop area with work benches General store Storage area for biomedical equipment 8 8 12 8 20 30 30 12 12 6 20 12 12 12 40 40 30 Trolley access necessary.
Sterilising unit should allow a one-way progression of instruments from ‘dirty’ to ‘clean’.

Includes airlock at entry.


May be shared with theatres Secure storage for equipment and tools Allow for storage of bulky equipment 131 Service/Function Functional requirements Area (m2) Notes Chemical store Medical gases Manager’s office with computer Technicians’ electronic work area Physiotherapy / Rehab Reception/clerical/ file storage area Waiting area Wheelchair park Interview/counselling room Gym area with space for up to 4 treatment cubicles and large open area for exercise programs.
Physio equipment store Occupational therapy room ADL kitchen ADL bathroom OT store Assessment/consult room – speech pathology 12 25 10 12 10 20 3 9 60 20 16 10 10 10 12 Must be wheelchair accessible.
Located to be accessible from both inpatient and outpatient areas 132 Service/Function Functional requirements Area (m2) Notes Mobility devices workshop Prosthetics/orthotics clinic room Prosthetics/orthotics workshop Office for OIC Office/work stations for therapy staff - shared Meeting/tutorial room General store Clean utility Dirty utility Accessible/assisted toilet - Shower rooms – accessible, male & female Beverage pantry/kitchenette Staff toilet and property bay.
Receiving area with window Record assembly/sorting and work table Coding/clerical work space 12 10 14 9 14 16 12 10 8 2 x 4 2 x 5 4 4 8 14 12 Medical records/health information Located externally but close to rehabilitation unit Staff tea room May be shared with wards?

Located near outpatient reception desk.

Includes desk for filing clerk.

File storage shelving (active) 40* Medical records storage.
May be compactus if space is limited and 133 Service/Function Functional requirements Area (m2) Notes structure permits * Less space required if systems are fully digitised.
Office – Officer in Charge Office/computer station for HIS officers Trolley holding bay Archive storage MANAGEMENT/ADMINISTRATION/EDUCATION Administrative offices Offices for Medical Superintendent Manager Nursing Manager General Services IT support Administrative staff Doctors (shared) Small meeting room To seat up to 8 people Large meeting/tutorial room Library Shelving for publications, reading area and computer station with internet access 9 14 6 40 12 25 30 Needs to be specified at each site Office – Manager (15 m2) Office – other (9 m2) Office – admin/clerical, shared (30 m2) Office – medical officers, shared (30 m2) 134 Service/Function Functional requirements Area (m2) Notes Conference/training room To seat up to 50 people Staff amenities Common/dining room with tea making facilities.
Male and female staff change areas with shower, toilets and lockers.

On call accommodation On call rooms for medical, nursing, medical imaging and laboratory staff 40 80 Motel style units with bedroom, ensuite bathroom and kitchenette.
GENERAL SUPPORT SERVICES Housekeeping Supervisor Office for housekeeping supervisor 9 Located near Laundry & cleaning store Kitchen/food service Office for head cook and dietitian Food preparation area Cooking area Tray assembly area Store for cooking equipment and crockery Cooked food storage area Food storage (dry, fresh and refrigerated goods) Dishwashing area 10 16 20 15 4 6 30 10 135 Service/Function Functional requirements Area (m2) Notes Trolley holding bay Bin area for hygienic disposal of kitchen waste.
Laundry Receiving area for soiled linen Area for washing machines and dryers Linen folding and sewing area Clean linen storage.

Outside area for line drying Cleaning Storeroom for cleaning equipment and supplies Transport and parking Covered parking space to store 3 vehicles.

Workshop with pit for maintenance of vehicles.

General storage area for fuel etc.

Mortuary Entry lobby/clerical Body preparation area Body viewing area Refrigerated storage drawers for 6-8 bodies.
Relatives waiting/gathering area Maintenance Office – maintenance supervisor Workshop – general 10 4 15 20 12 30 30 6 6 6 8 12 25 10 40 Located outside but adjacent to kitchen.

May be partially covered.

Located adjacent to kitchen area and supervisor’s office Room should be temperature controlled and have direct access from outside for ambulance and funeral vehicles.

Freezer provision?

External, covered area adjacent to viewing area.


136 Service/Function Functional requirements Area (m2) Notes Store – general Groundsman’s store Bulky equipment storage Protected area suitable for storage of spare beds, trolleys, wheelchairs, etc.

Oxygen store Staff Amenities Staff dining room/cafeteria Staff showers and change rooms Waste management Rubbish collection point and bin storage.

Hostels / Accommodation Secure holding for surgical waste, sharps containers and expired medications.
Incinerator Sewage treatment plant Staff Accommodation – 3 Bedroom Staff Accommodation – 2 Bedroom Staff Accommodation - Dormitory Maternity waiting or referral waiting accommodation 50 20 40 20 TBD TBD 20 6 40 TBD 74 65 12 45 High temperature incineration system for medical and general waste, including glass, sharps & combustible biohazard material.
Dependent on capacity requirements Doctors, Senior Nurses, Allied Health workers and Senior Administration with families Managers, Nurses, allied health workers with families Per dormitory bedroom with access to shared ablutions Per unit with ablution access 137 HOSPITAL FACILITY PLANNING STANDARDS • Inpatient beds – population-based planning: WHO standard 3.3 per 1000 population.
Vanuatu 2014 – 1.7 beds per 1000 population PNG standard – 2.7 beds per 1000 population • Inpatient Beds – requirement to be based on patient days and target occupancy rate.

Proposed occupancy rates – 75% for referral hospitals – 70% for maternity ward – 65% for paediatric ward & HDU/ICU – 65% for provincial hospitals Lower rates may be justified in some situations eg small, isolated hospitals.
Future demand may be based on population growth and expected hospital utilisation rates (average patient days per 1000 population).

Generally, utilisation rates might be expected to increase as services are upgraded.

• Outpatient Clinics - GOPD - one consultation room/treatment place* per 6,000 attendances per year (about 24 patients per day, 50 weeks per year) - Assumes efficient use of consultation rooms.
• Emergency Department – One treatment place* per 3,000 attendances per year (about 8.5 pts/day) – Excludes resuscitation bay • Birthing – Labour ward: 1 bed per 250 births p.a.

– Delivery ward: 1 bed per 500 births p.a.

(minimum = 1 bed) – Combined birthing unit: 1 bed per 300 births p.a.

• Operating theatres – One theatre per 1,200 operations p.a.
– Day surgery/minor procedures: one per 2,200 procedures Treatment place = consult room, bay with bed/trolley, cubicle or specific treatment (eg nebuliser) station 138 APPENDIX E MINIMUM ESSENTIAL EQUIPMENT 139 APPENDIX E1: MINIMUM ESSENTIAL EQUIPMENT PRIMARY HEALTH CARE FACILITIES - EQUIPMENT LIST (MINIMUM STANDARD) Medical Assets and Inventory Quantity Additional Information Serial Item Description AP D RD HC EHC Specifications Accessories MOH Brand Bag, Artificial Manual Breathing Unit (AMBU), Adult 1 1 1 1 1 Bag, Artificial Manual Breathing Unit (AMBU), Child 1 1 1 1 1 Bag, Artificial Manual Breathing Unit (AMBU), Infant (Newborn) 1 1 1 1 1 Bed, Cot, Infant, Singlet 0 1 2 3 3 Withstand autoclave to 134deg C temp, Bag volume 1700ml total, expiry resistance of 2.2cms of water, inspiratory resistance of 3.3cms of water, controlled flow rates, port for connection of oxygen Withstand autoclave to 134deg C temp, Bag volume 500ml total, expiry resistance of 2.2cms of water, inspiratory resistance of 3.3cms of water, controlled flow rates, port for connection of oxygen Withstand autoclave to 134deg C temp, Bag volume 300ml total, expiry resistance of 2.2cms of water, inspiratory resistance of 3.3cms of water, controlled flow rates, port for connection of oxygen Surface lying area: 900mm x 2000mm, height adjustment range: 350mm - 850mm, Safe capacity: 170kg (27 stone) including client, mattress and accessories, Side rail height: 750mm, External dimensions: 1000mm x 2170m Bed, Examination, Adjustable Head 1 1 1 2 2 L = 2.0m, W = 0.75m, H = 0.46 - 0.90m, Working Load 180kg, Adjustable Head Carry Case Carry Case Carry Case Mattress, pillow, linen Roll for disposable surface (for infection control) Medicraft, Hill- Rom 6 Bed, In-Patient, Single, Manual 0 4 6 6 6 Lying surface dimensions: 2000mmL x 1100mmW, Height adjustable: min 270mm - max 750mm, Safe capacity: 300kg including client, mattress and accessories Mattress, Pillow, Linen Medicraft, Hill- Rom 7 Bed, Mechanical, Birthing 0 1 1 1 1 Lying surface dimensions: 2000mmL x 1100mmW, Height adjustable: min 270mm - max 750mm, Safe capacity: 300kg including client, mattress and accessories, calf support options, two (2) IV pole inserts, castors for movement Mattress, Pillow, Linen Hill-Rom 140 Medical Assets and Inventory Quantity Additional Information Serial Item Description AP D RD HC EHC Specifications Accessories MOH Brand L = 2.0m, W = 0.75m, Aluminium Frame, PVC Coated, Polyester bed with antibacterial, stain, chemical and crack resistant.
Rubber Handles.
Working Load 180kg Carry Case Bed, Stretcher, Portable Bedpan Bottle, Humidifier, Oxygen Concentrator Bowl, 4 Litre Cabinet, Bedside, Lockable Cannister, Gauze Cannister, Cotton Wool Clock, Analogue Compressor, Nebuliser Crutches, Adult Crutches, Youth Cutter, Stitch, Sterile Cylinder, Oxygen, G size Dish, Kidney, 0.75 Litre Aluminium for durability and infection control, Length: 380mm, Width: 270mm, Depth: 65mm 360 degree moulded, low resistance, transparent Standard fitting for attachment to flowmeters and concentrator outlets Plastic or aluminium, Width 350mm minimum Depth: 65mm minimum 2 x drawer, 1 x lockable, open shelf or cupboard under.
Preferably waterstain resistant coating Stainless Steel, 0.4L, Push lid Stainless Steel, 0.4L, Push lid Round Face, Approx 350mm face, black on white, AA battery Free Air Flow: ≥8lpm, AC/DC power Max.

user weight: 127kg (20 stone), Top to floor: 1340mm - 1540mm, (Client height 5'10" - 6'6".)

22mm tip.

22mm tip, Max.

user weight: 127kg (20 stone), Top to floor: 940mm - 1140mm, (Client height 4'6" - 5'2".)

2 2 2 2 Stitch Cutter Blade that does not require handle for use.
2 10 2 10 3 10 3 10 Type 10 'Bullnose' fitting as per current cylinders in use through MoH.
Stainless Steel, L = 250mm, H = 55mm, V = 750ml N/A N/A N/A N/A Nebuliser Kits, tubing, Filter, Adult and Paeds Mask N/A N/A N/A N/A N/A Swann Morton Disposable Stitch Cutter Blades BOC 141 Medical Assets and Inventory Quantity Additional Information RD HC EHC Specifications Accessories MOH Brand 4 6 6 Wall mounted, Takes 1000ml refills, size 29 x 16 x 11cm or similar 500ml - 1000ml refills Serial Item Description AP Dispenser, Sanitiser, Wall Mounted Forceps, Artery Forceps, Dissecting Forceps, General Forceps, Sponge Holder, Needle Holder, Scalpel, Metal Holder, Suture Jug, Graduated, 1 litre 1 0 0 2 2 0 0 1 D 12cm 12cm 12cm 12cm 12cm To fit scalpel sizes: 11/12/15/20/21/22 12cm 2 3 3 3 Plastic, 50ml graduations Light, Examination, LED, Portable 0 1 1 2 2 Stand light, Flexible head, adjustable intensity preferable, stable platform, castors, 5-10W LED power.
Battery backup an advantage but not essential.
32 Mattress, Bed, Single 0 4 6 6 6 To fit Bed, inpatient, single Pillows, Pillowcase, linen sheets 33 Medicine Cup, Graduated, 250ml 2 4 4 6 6 Plastic, Up to 250ml 34 Meter, Blood Glucose 0 2 2 3 3 Test time - 5 seconds, Power supply - AA Battery or Lithium CR2032 Memory capacity -500 blood glucose results Additional features: Auto power on when test strip inserted; Auto power off after 60 seconds Carry Case, test strips Roche Accu- Chek Performa (superseded by Performa II) 142 12cm 12cm 12cm 12cm N/A N/A N/A N/A N/A Mayo-Hegar Mayo-Hegar Mayo-Hegar Mayo-Hegar Mayo-Hegar Mayo-Hegar Welch Allyn GS300 (expensive) - cheaper but just as effective options available Medical Assets and Inventory Quantity Additional Information Serial Item Description AP D RD HC EHC Specifications Accessories MOH Brand 35 Meter, Flowmeter, Oxygen, 0- 15LPM 0 4 6 6 6 400kPa pressure capacity, Highly accurate, easy to read, Durable chrome-plated brass body, Shatter resistant polycarbonate Thorpe tube, 1 LPM graduations full scale Nozzles for tubing attachment 36 Meter, Hemoglobin 0 1 1 1 1 37 Meter, Pulse Oximeter, Fingertip 0 2 2 3 3 Precise factory calibration against the ICSH reference method, uses microcuvette technology, date and time storage for up to 600 results Blood-based liquid controls Patient Range: Adult and Paediatric, SpO2 Measurement Range: 70%-99%, Resolution: +/- 1%, Measurement Accuracy: 80%-99%: +/- 2%, 70%-80%: +/-3%, Pulse Rate Measurement Range: 30-235 bpm, Resolution: +/- 1bpm, Measurement Accuracy: 33-99 bpm: +/- 2 bpm, 100-235 bpm: +/- 2 bpm Microcuvettes (consumable) Radiometer Hemocue 201+ Carry Case Conmed 38 Meter, Sphygmomanometer, Aneroid 1 2 2 3 3 Certified accuracy to +/- 3mmHg, Latex free for safety, Durable one-piece Adult cuff - 25 - 34cm, Durable one- piece Child cuff - 15 - 21cm, Polyester zip case Carry Case 39 40 41 42 Meter, Thermometer, Ear, Infrared 0 1 1 1 1 Auto shut off, memorises readings, Use with Ear covers, reading in under 2 seconds, AA or AAA batteries Meter, Thermometer, Standard, Digital 1 2 2 4 4 Monitor, Blood Pressure, Digital 1 1 Monitor, Doppler 0 1 1 1 1 1 1 1 Digital display, Celsius calibration, self timing, mercury free, hard tip, audible warnings, utilises standard coin cell battery, eg LR44 120 Memories Recall, One-touch operation, Fully auto measurements, WHO pressure level indicator, Low battery detection, Auto power off function, AC-DC option, standard batteries - AA or AAA.
Fixed probe 2-3MHz (2 general, 3 early gestation), standard alkaline batteries - AA, AAA or 9V Carry Case, water- based coupling gel Contec, Huntleigh, Edan 143 Welch Allyn, Reister, Baunmanometer N/A - suggest Braun 6021, Covidien Genius 2 Carry Case, infrared ear thermometer probe covers covers for tip (eg for oral use) Adult and Paediatric Cuffs N/A - suggest Omron HEM-907 or similar Medical Assets and Inventory Quantity Additional Information RD HC EHC Specifications Accessories MOH Brand Serial Item Description 43 44 Net, Mosquito, Cot Pole, IV, Mobile AP 0 0 45 Pump, Suction, Manual, Foot 0 46 47 Refrigerator, Chill, Vaccine, 20 Litre, Solar Refrigerator, Chill, Vaccine, 36 Litre, Solar 0 0 D 1 4 1 1 0 2 6 1 1 0 3 6 1 0 1 3 6 1 0 1 LLIN treated, to fit cot dimensions 900mm x 2000mm +100mm and 1000mm drop Height: 1220mm - 2100mm, Aluminium (or SS for durability), Castors, Dual Head (for two IV Bags) Hand or foot operation, 600ml fluid capacity, maximum free air flow 70 litres / min, autoclavable TCW15SDD Solar Refrigerator, R600a refirgerant, 20 Litre minimum capacity TCW40SDD Solar Refrigerator, R600a refirgerant, 36 Litre minimum capacity 48 Refrigerator, Blood 0 1 1 1 1 49 Rod, Height, Wall Mounted 50 51 52 53 54 55 56 Scale, Weighing, Adult Scale, Weighing, Child Scale, Weighting, Newborn Scissors, Bandage, 14cm Scissors, Clothing Cutters, Large, 17.5cm Scissors, Clothing Cutters, Small, 15cm Scissors, Dressing, Blunt / Sharp, 13cm +4degC, multiple alarms (temp deviation, power disruption etc), temperature logging function, battery back-up (or UPS), capacity ≥20 x 450mL blood bags Wall Mounted, Stadiometer, level scale indication, scale and head piece in moulded plastic, measures in inches and centimetres 180kg load capacity, 10 x 15 inch platform, manual slide scale or clock face with calibration setting 25kg load capacity, 15 x 22 inch platform, manual slide scale 10kg load capacity, hanging scale As per item description,
 angled blades As per item description, angled blades As per item description, angled blades As per item description Ceiling Hooks Spare Castors Suction tips N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Dometic, Vestfrost, B Medical System Dometic, Vestfrost, B Medical System Seca Seca 144 Medical Assets and Inventory Quantity Additional Information Serial Item Description AP RD HC EHC Specifications Accessories MOH Brand 57 Scissors, Dressing, Blunt, 13cm Scissors, Dressing, First Aid, 8.9cm Scissors, Suture, 30cm Scope, Fetoscope D 1 1 2 1 1 1 0 0 2 2 4 1 2 2 4 2 2 2 4 2 Scope, Ophthalmoscope, Handheld 0 1 1 1 1 58 59 60 61 62 Scope, Otoscope, Fibre Optic 0 63 64 Scope, Stethoscope, Double Head, Adult Scope, Stethoscope, Single Head, Paeds 65 Screen, Privacy, Portable 66 67 Sheets, Bed, Single Speculum, Stainless Steel, Set 0 1 1 0 0 68 Steriliser, Autoclave, Powered Steriliser, Autoclave, Steam 1 1 1 1 1 As per item description As per item description As per item description Metal for durability and cleaning, 8 inch or more Should be rechargeable battery with Charger / mains operated, LED light source, red-free filters, small and large spot sizes, fixation targets, slit aperture, hemi-spot and cobalt blue filter, wheel control with lens powers ranging from +20D to -35D in single dioptre steps up to 10D and 5D steps above that, illuminated lens dial, rubber brow rest, dust free optics and a spherical optical system.
Interchangeable head with ophthalmoscope above.

Handle contains rechargeable battery.

Should be LED illumination Adult Head Paediatric Single panel width: 300mm, 4 x p[anels, Base dimensions: 590mm L x 400mm W, Weight: 22kg, Panel height: 1650mm, Accordion system, rubber stop mounted To fit Bed, inpatient, single 1 set consists of 1 x Small, 1 x Medium and 1 x Large Class B, 18-22L minimum.

Minimum 5-tray capacity.

Must be provided with water distiller (for de-calcification) or some other source.
Capacity as above, pressure and temperature indication, stainless steel construction, gas cooktop OR wood fired heat N/A N/A N/A N/A Carry Case Welch Allyn, Reister, Heine Welch Allyn, Reister, Heine Carry Case Carry Case Carry Case N/A N/A SIMS Ritter and Tuttnauer or Rexmed N/A Distilled water, chemical indicators to test for effective sterilization Gas bottle and line (If gas fed) 145 Medical Assets and Inventory Quantity Additional Information Serial Item Description AP D RD HC EHC Specifications Accessories MOH Brand Stool, Foot 01 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Tape, Measuring, Handheld Tape, MUAC, Adult Tape, MUAC, Child Tray, Dressing Tray, Instrument, Square Tray, Over bed, Portable Tray, Pelvic Tray, Suture Tray, Urine, Male Tray, Urine, Female Trolley, Instrument / Dressing, 2-Drawer Trolley, Medication, 2-Drawer Tweezers, Angle Tip, 11cm Tweezers, Pointed Tip, 11cm Vaccine Carrier, small, 0.9 Litre 86 Vaccine Carrier, small, 1.5 Litre 87 Vaccine Carrier, small, 2 Litre 88 89 Vaccine Cold Box, large, long range 20ltr Vaccine Cold Box, large, short range 15ltr Single step.
Tubular pipe framework.

CRC sheet top (fitted with non-skid rubber sheet) or an SS top.

Rubber/PVC stumps.

Approx Dimensions (LxWxH): 460x230x230mm.

Pre-treated & Epoxy powder coated finish.
Plastic coated, metal tips, 2.0m length Non-tear, non-stretch Non-tear, non-stretch Stainless Steel, 20cm x 15cm Stainless Steel, 30cm x 30cm Adjustable, on castors, lockable height dial Stainless Steel, 20cm x 15cm Stainless Steel, 20cm x 15cm Plastic moulded, 1 litre capacity, with lid Plastic moulded, 1 litre capacity, without lid Castors, Two drawer, Plastic tray top, 1000mmW x 500mmD x 900mmH Castors, Two drawer, Plastic tray top, 1000mmW x 500mmD x 900mmH As per item description As per item description Insulated container, minimum cold life of 24 hours Insulated container, minimum cold life of 24 hours Insulated container, minimum cold life of 24 hours N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Spare Castors Spare Castors N/A N/A Ice Packs 0.3,0.4 and 0.6 litres Ice Packs 0.3,0.4 and 0.6 litres Ice Packs 0.3,0.4 and 0.6 litres Products between 15 - 25 litres, minimum cold life of 96 hours Ice Packs 0.3,0.4 and 0.6 litres Products between 15 - 25 litres, minimum cold life of 48 hours Ice Packs 0.3,0.4 and 0.6 litres 146 Medical Assets and Inventory Quantity Additional Information Serial Item Description 90 91 Vaccine Cold Box, small, long range 10ltr Vaccine Cold Box, small, short range 5ltr AP 0 0 92 Vacuum, Aspiration, Manual 0 D 1 1 1 93 Vacuum, Extractor, Delivery, Manual 0 RD HC EHC Specifications Accessories MOH Brand 1 1 2 1 2 2 2 2 2 2 2 2 Products between 5- 15 litres, minimum cold life of 96 hours Ice Packs 0.3,0.4 and 0.6 litres Products between 5- 15 litres, minimum cold life of 96 hours Ice Packs 0.3,0.4 and 0.6 litres ≥70l/min flow, ≥600mmHg vacuum, ≥1000mL capacity, foot-operated, easy clean Tubing, canisters, one- way valves Low-profile cup, ease-of-use Cups (disposable) Ambu Twin Kiwi vacuum Delivery System - Omni-cup or Omni-MT 94 Wheelchair, Adult 1 1 1 2 2 Back height: 450mm, Floor to seat height: 510mm, Overall width: 760mm, Overall length: 1120mm, chair weight: 24kg, Max.
user weight: 204kg, Seat width: 560mm N/A 147 PRIMARY HEALTH CARE FACILITIES – NON-MEDICAL FIXED ASSETS AND INVENTORY Assets and Inventory (Non-Medical) Serial Item Description 26 Vehicle, Utility, 4WD, Double Cabin All-Terrain Vehicle (ATV), Quad, 4WD Boat, Fibreglass, 7m Boat, Aluminium, 4.5m Motor, Outboard, 40HP Motor, Outboard, 10HP Power System, Generator, 5kVa Power System, Generator, 10kVa Power System, Solar Unit, 1000W Power System, Solar Unit, 300W Power System, Solar Unit, 100W Computer, Laptop, Government Specification Hard Drive, 1TB, Mobile Cabinet, Filing, Vertical, 3-Tier Cabinet, Filing, 3-Tier, Pedestral Cabinet, Bookshelf, 4 Tier Cabinet, Bookshelf, 1-Tier, Wall Mounted Cabinet, Storage, Pharmaceutical Cabinet, Kitchen, Storage Extinguiser, Fire, Wood, 1L Sink, Stainless, 35L Sink, Porcelin, Handbasin Table, desk, 1.8m Table, sorting, 1.8m Chair, Manager Functional Area Garage Garage Other Storage Other Storage Other Storage Other Storage Generator Shed Generator Shed Generator Shed Generator Shed Generator Shed Consultation Room Consultation Room Consultation Room Consultation Room Consultation Room Consultation Room Pharmaceutical Storage Delivery Room Various Ablutions (WC) - Internal Consultation & Treatment Room Pharmaceutical Storage Consultation Room AP D RD HC EHC - - - - - - - - - - 1 - - - - - - 1 - - - - 1 - 1 - 1 - - 1 1 1 - - 1 - - - 1 1 1 1 1 1 2 3 2 2 1 1 1 1 1 1 1 1 1 1 - 1 - 1 1 1 1 1 1 1 1 3 3 2 2 1 1 1 1 1 1 2 2 1 1 1 - - 1 1 1 1 1 1 1 1 3 3 2 2 1 1 1 1 1 1 2 2 1 1 1 - - 1 1 1 1 1 1 1 1 3 3 2 2 1 1 148 Serial Item Description 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Chair, Consultation Chair, Visitor Chair, Bench Seating, 2.4m Bin, Rubbish, 10L Clock, Wall Mounted Bucket, 20L Mop, 1.5m Tank, Water, 5,000L Tank, Water, 10,000L Ablutions, Toilet, Flush System Ablutions, Toilet, VIP, Double Bedding, Pillow Bedding, Pillowcase Bedding, Linen, Single Bedding, Linen, Cot Note: Assets and Inventory (Non-Medical)
 Functional Area Consultation Room Inpatient Wards Outpatient Waiting Area Consultation & Treatment Room Consultation & Treatment Room Other Storage Other Storage Water Storage Water Storage Ablutions (WC) - Internal Ablutions (WC) - External Various Various Various Various AP 1 1 2 1 1 1 - 1 - - - - - - - D 2 4 5 1 2 2 2 - 1 2 1 4 8 16 2 RD HC EHC 2 6 5 2 2 2 3 1 1 2 1 6 12 24 4 2 6 7 2 2 2 3 - 3 2 2 6 12 24 6 2 6 7 2 2 2 3 - 3 2 2 6 12 24 6 1.
Vehicles and Boat allocation is dependent on location.

Facilities may hold vehicles but not boats and vice versa.

Where there is justification to hold both (with access to sea and road routes) this is permitted.

2.

Boats are inclusive all safety equipment, such as lifejackets, oars, EPIRB, nautical maps, flares (and gun), navigation lights and marine compass.

3.

Outboard motors are dependent on final boat allocation.

4.

Solar system numbers are indicative of individual health facilities.
Additional systems will be required for staff housing (300W systems) 5.
All furniture is to be suitable for tropical climate (I.e Anti-corrosion etc) 149 HOSPITAL FACILITIES – EQUIPMENT LISTS SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital EMERGENCY AND CRITICAL CARE APPENDIX E2: HOSPITAL FACILITIES MEDICAL EQUIPMENT Emergency resuscitation trolley – adult & paediatric As for Provincial Hospital PLUS: As for Regional Referral Hospital PLUS: Emergency Department Defibrillator, external automated ECG machine (12 lead) Stethoscopes - mechanical Sphygmomanometers (adult, child cuffs) Thermometers (digital) Glucometer Ventilator (adult, paediatric portable) Cardiac monitor Oxygen cylinders and regulator Flow meter (oxygen therapy) Multi-channel infusion pump Multiple channel syringe pumps Central monitor (that links with all bedside monitors) Portable echocardiography/Ultrasound machine Laboratory unit – emergency diagnosis - point-of- care test devices for lab tests e.g.
Wall-mounted oxygen and suction systems - iSTAT device for Hb, blood gas analysis and UEC Glucometer with ketometer Urinalysis meter - - Pulse oximeter - additional Laryngoscope, adult/child, set Mobile X-ray machine Endotracheal suction equipment Paediatric warmer Spirometer/peak flow meter Diagnostic set (otoscope, ophthalmoscope) O&G emergency trolley and sets Larnygoscope, adult/child set Airways tubes, endotracheal tubes & masks (adult & child) Suction machine (manual) 150 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Nebuliser Infusion pump and drip stand Syringe pump x 2 (for IV medication) Examination light (portable) Humidifier & regulator Oxygen concentrator Oxygen cylinder - portable Urinary catheterisation equipment Nasogastric drain tubes and collection bag Emergency drug kit Scales Plaster saw IBlood/V fluid warmer Patient transport trolley & slide Emergency light with rechargeable battery Communication: Satellite phone or radio communication Whiteboard or similar PC Workstation linked to referral hospital and PACS and on-line education tools etc 151 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Retrieval & emergency transfers Stethoscope Sphygmomanometer glucometer Portable defibrillator As for Provincial Hospital PLUS: As for Regional Referral Hospital PLUS Portable resuscitator with adult and child masks IV set Portable suction unit Portable resuscitator with adult and child masks Cardiac monitor AMBU bag Guedal airways tubes Thomas stretcher HDU/ICU NB: HDU is part of general medical-surgical ward so equipment is shared.
Essential for HDU are: Separate unit.

Equipment as for Provincial Hospital PLUS Free standing unit.

Equipment as for Regional Referral Hospital PLUS Emergency/Resuscitation trolley (may be shared with ED) Scale, patient, bed Light, examination, mobile Oxygen set Suction unit (manual) Infusion pump, multichannel IV drip stand Sphygmomanometer, aneroid Emergency resuscitation trolley, fully equipped including adult and paediatric laryngoscope sets.
Portable patient monitor [ blood pressure, non- invasive, ECG, Oximetry, temperature].

Suction system, general purpose, electric Portable ventilator, adult/paediatric (short term use) Flow meter, oxygen therapy Ophthalmoscope & otoscope Wall mounted oxygen and suction (2 per bed) Portable monitor: NIBP, oximeter, ECG, capnometer, temperature, pressure channels (1 per bed) Ventilator, mechanical, adult/paediatric Central telemetry (cardiac) monitoring Patient monitor, blood pressure, invasive.
Patient monitor, electrocardiographic/respiratory Glucometer with ketometer Urinalysis meter 152 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Point-of-care test devices for lab tests [e.g.
iSTAT device for Hb, blood gas analysis and UEC] Gasometer Access to mobile X-ray As for Provincial Hospital PLUS: As for Regional Referral Hospital PLUS: Stethoscope, mechanical Pulse oximeter ECG machine (may be shared with ED/OPD) Glucometer Thermometer, electronic Nebuliser (electric) Dressings trolley Wheelchair Patient transport trolley MEDICAL General outpatient clinic services Scales – adult Height scale Stethoscopes Sphygmomanometers – aneroid with adult and child cuffs ECG machine (12 lead) Portable cardiac monitor Glucometer Thermometers – digital 153 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Pulse oximeter Diagnostic set (otoscope, ophthalmoscope) Examination lamp Nebuliser (electric) Infusion pump and drip stand Dressings trolley Lockable drugs trolley/cabinet RDT kits X-ray viewing box or monitor/screen for digital images Vaccine fridge (may be shared with paediatric outpatients) Patient transport trolley Specialist outpatient clinic services As above 154 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Medical ward: equipment as for Provincial Hospital PLUS: Medical ward(s): equipment as for Regional Referral hospital PLUS: Emergency resuscitation trolley Physiologic monitors for high dependency beds.
Echocardiography unit – portable Ultrasound machine - portable Defibrillator Cardiac Monitor Neurology set Oxygen cylinder - portable Oxygen concentrator Oxygen and suction – wall mounted Computer monitor for imaging, lab results Portable suction unit Syringe pump Bone marrow biopsy set Spirometer Inpatient care Medical-Surgical ward Scales – adult Height scale Stethoscopes Sphygmomanometers – aneroid ECG machine (12 lead) Glucometer Thermometers – digital Pulse oximeter Diagnostic set (otoscope, ophthalmoscope) Examination lamp Nebuliser (electric) Infusion pump IV drip stands Dressings trolley Lockable drugs trolley/cabinet X-ray viewing box or monitor Fridge – vaccines & drugs Wheelchair, mobility aids 155 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Emergency Resuscitation trolley (shared with ED/OPD) SURGICAL Surgical clinics As for general outpatient clinic plus: As for provincial hospital PLUS: Proctoscope Flexible sigmoidoscope Specialist clinics As above plus: As for Provincial hospital plus: As for Regional Referral hospital Plaster saw (Orthopaedics/fracture) Cystoscope, flexible (Urology) Urodynamics system (Urology) Surgical procedures See operating theatres See operating theatres See operating theatres Inpatient care – surgical wards As for medical inpatients plus: As for Provincial hospital plus: As for Regional Referral hospital PLUS Plaster saw/cutters Emergency resuscitation trolley Ultrasound machine - portable Defibrillator 156 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Cardiac Monitor Oxygen and suction – wall mounted Computer monitor for imaging, lab results Syringe pump Procedure trolley Dressing trolley POP trolley and accessories Traction frame bed(s) Ripple mattress Patient transport trolley Eye/Ophthalmology services Amsler’s eye chart Ishihara colour testing chart Head lamp Slit lamp?
Examination lamp Eye retractor Ophthalmoscope/retinoscope set Magnifying loop Trial lens set As for provincial hospital PLUS: As for regional referral hospital PLUS: Slit lamp with 90D lens Fundus camera Indirect ophthalmoscope Laser (details?)

Argon?

Corneal pachymeter/ Keratometer Visual field analyser Glucometer?
157 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Dressing trolley ENT services Otoscope As for provincial hospital PLUS: As for regional referral hospital PLUS Examination lamp Suction unit Audiometer Tympanometer Head lamp with light source Operating sets – ENT (in operating theatre) Nasofibroscope (flexible & rigid) Audiometry testing booth Operating microscope (in operating theatres) Oral Health/Dental Dental chair with light, drill and suction unit As for provincial hospital PLUS: As for regional referral hospital Dental handpieces Benchtop steriliser/autoclave Compressor unit (if required) Blood pressure monitor Glucometer Portable dental unit for outreach service Portable autoclave Wall mounted X-ray machine with monitor Biosonic cleaner Suction unit – dental, portable Intra-oral X-ray processor Dental laboratory and prosthodontics workshop equipment Burns N/A N/A Burns bath MATERNAL AND REPRODUCTIVE HEALTH Antenatal & postnatal clinics Scales, adult and baby As for Provincial Hospital PLUS: As for Regional Referral hospital Measuring tape Cardiotocograph (CTG) machine 158 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Sphygmomanometer/blood pressure monitor Ultrasound scanner Examination light Foetal stethoscope/heartbeat monitor Stethoscope Thermometer, clinical Pregnancy wheel/gestation calculator Examination table with stirrups Dressing trolley RDT kits Access to ultrasound scanner (mobile) Antenatal high-risk clinic As for antenatal May have CTG?
As for Provincial Hospital PLUS: As for Regional Referral hospital Cardiotocograph (CTG) machine Ultrasound scanner Gynaecology, family planning/women’s health clinics Delivery and intrapartum care As for antenatal PLUS As for Provincial Hospital PLUS: As for Regional Referral hospital Colposcope Pap smear kit Cryotherapy unit Examination bed/couch As for Provincial Hospital PLUS: As for Regional Referral hospital Examination light Wall clock Labour/Delivery beds with accessories CTG machine Ultrasound scanning unit Suction unit, electric 159 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Drip stands Infusion pumps Syringe pump Nebuliser pump Sphygmomanometer, aneroid Emergency resuscitation trolley Stethoscope (adult) Foetoscope Partograph Ultrasound scanner, mobile Foetal heart monitor (mobile) Bakri balloon (control severe PPH) Steriliser for instruments Vacuum extraction set, manual Scale, infant, beam type Emergency resuscitation trolley, equipped for adult and newborn resuscitation.
Pulse oximeter Oxygen cylinder or concentrator, with accessories Pump, suction, foot operated or electrical Suction bulb (Laederl ‘Penguin’ suction device) Pump, suction, newborn resuscitation 160 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Newborn warmer/resuscitation trolley Patient transport trolley Inpatient care Scale, adult As for Provincial Hospital PLUS: As for regional referral hospital ECG machine (12 lead) Monitor for high dependency bed Oxygen Suction Glucometer Ultrasound machine – portable Scale, infant, beam type Examination light, portable Sphygmomanometer, aneroid Stethoscope (adult) Thermometer, clinical Speculum Infusion pump Drip stands Nebulizer with accessories Pulse oximeter Syringe pump with accessories Computer for RMNCAH data entry?
Wheelchair Gynaecological surgery & Caesarean sections As for Operating Theatres As for Provincial Hospital PLUS: Sexual violence As for Women’s health clinics 161 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital NEWBORN, CHILD & ADOLESCENT SERVICES Newborn care Scale, infant, digital As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS: Newborn resuscitation table with accessories Suction Resuscitator, hand operated, newborn set Oxygen concentrator, flow splitter, for newborn.
Special care nursery/NICU Child Health/Paediatric clinics Humidicrib/incubator (neonatal) As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS: Warmer, heating pad, newborn Scale (digital) Phototherapy trolley/light Infusion pump Pulse oximeter Neonatal Continuous Positive Airway Pressure (CPAP) system Intensive care cots with mechanical ventilator (neonatal) Warmer, radiant heat, free standing, neonatal Cardiac or multi-system monitors Infusion pump with accessories x 2 Syringe pumps Bilirubinometer Apnoea monitor Infusion pumps Sphygmomanometer – 1 per cot Auditory function screening device, newborn Thermometer – 1 per cot X-ray viewer/monitor Syringe pump Scales: infant and child As for Provincial Hospital PLUS As for Regional Referral Hospital Height scale Mid Upper Arm Circumference (MUAC) measuring tapes: infant/child ECG machine Pulse oximeter Diagnostic set 162 SERVICE CATEGORY Provincial Hospital Thermometer, clinical Regional Referral Hospital Oxygen cylinder – portable National referral Hospital Examination light Oxygen concentrator Audiometer, pure tone Fridge - medications Otoscope Podoscope Stethoscope Sphygmomanometer, aneroid with paediatric cuff Paediatric examination table X-ray viewer or monitor Vaccine fridge Scales: infant and child Height scale Paediatric inpatient care As for Provincial Hospital PLUS As for Regional Referral Hospital PLUS: Oxygen set (mobile) Cardiac monitor ECG machine Defibrillator Blanket warmer Mid Upper Arm Circumference (MUAC) measuring tapes: infant/child Examination light Thermometer, clinical Timer, respiration for ARI Infusion pump Drip stand, double hook 163 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Nebulizer with accessories Pulse oximeter, portable with accessories Access to X-ray viewer or monitor MENTAL HEALTH Psychiatric ward Refer to medical ward Refer to medical ward Scales – adult Stethoscope Sphygmomanometer – aneroid ECT machine with EEG monitor Thermometer – digital Examination lamp IV
 drip stand Dressings trolley Lockable drugs trolley/cabinet Fridge – medications Wheelchair ALLIED HEALTH/CLINICAL SUPPORT SERVICES Pharmacy Pill counters As for Provincial Hospital As for Regional Referral Hospital PLUS: Drug fridge Medicine trolley Cytotoxic cabinet for oncology pharmacy 164 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Lockable storage cabinet for dangerous drugs Computer terminal for M-supply Pathology/Medical laboratory services Haematology Haematology As for Regional Referral Hospital PLUS: Haematology analyser (100) Haematology analyser (550) Haematology analyser (1000) Coagulation unit Microscope Blood gas analyser Biochemistry General analyser – semi-automated, dry chemistry GeneXpert – PCR Microbiology Incubator Autoclave Serology Rotator and mixture Coagulation unit Automated coagulation unit Automated slide stainer Blood culture machine Microscope Centrifuge Blood gas analyser Biochemistry - as for Provincial Hospital Biochemistry - as for Regional Referral Hospital PLUS Analyser – automated, wet chemistry [Cobas C311] Immuno-Assays Molecular Biology Microbiology - as for Provincial Hospital PLUS PCR machine Blood culture machine Serology - as for Provincial Hospital PLUS Microbiology - as for Regional Referral Hospital Serology - as for Regional Referral Hospital ELISA HPV Safety cabinet Histology/Cytology Tissue processor Embedding centre Microtome- semi-automated Water bath Incubator Automated stainer 165 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Safety cabinet Blood Bank Automated scale/pulse/bleeding machine As for Provincial Hospital PLUS: As for Regional Referral Hospital Haemocue Blood separator Blood donation couch Small blood fridge Mobile blood donation vehicle Blood irradiator Apheresis machine Automated ESR Blood rotator Scales (blood) Sealer (blood bank) Warmer Medical imaging Fixed X-ray (digital, with PACS capability) As for
 Provincial Hospital PLUS: As for Regional Referral Hospital PLUS: X-ray table Developing Processor Ultrasound scanner (basic) Digital X-ray with monitors in ED, OPD and wards and PACS capability.
OPG CT scanner Emergency resuscitation trolley Mobile x-ray Ultrasound - colour doppler Image intensifier (in theatre) Fluoroscopy (IVU and contrast studies) Clinical investigations ECG machine (located in ED) As for Provincial Hospital PLUS: As for Regional Referral Hospital PLUS: Echocardiograph with accessories Exercise stress test Operating theatres + Endoscopy Operating table, with accessories As for Provincial Hospital PLUS: As for Regional Referral Hospital PLUS Electrosurgical unit, with accessories Light, operating theatre, ceiling, with accessories Mobile X-ray, with viewer and accessories.
Surgical/operating sets for: Image intensifier Diathermy - - - - Head and neck surgery Spinal surgery Thoracic surgery Hand surgery 166 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Light, operating theatre, mobile, with accessories Surgical/operating sets for: Electrical vacuum aspiration (EVA) full set Manual vacuum aspiration (MVA) complete set Pump, suction, electrical, 1 bottle with accessories Pump, suction, electrical, 2 bottles with accessories - - - - - - - Abdominal surgery Orthopaedics Plastic surgery ENT surgery Ophthalmic surgery Facio-maxillary surgery Paediatric surgery Sphygmomanometer, aneroid Stethoscope (adult) Tourniquet, rubber, approx.
50cm Endoscopic sets (gastroscope, colonoscope, cystoscope, bronchoscope) Endoscope rinsing/disinfecting bath Anaesthetics Anaesthetic machine.

As for Provincial Hospital PLUS: As for Regional Referral Hospital Defibrillator, basic with accessories Laryngoscope, adult/child set Oxygen concentrator, with accessories Pulse oximeter Infusion pump Pump, suction, foot operated Resuscitator, hand operated, adult set.

Anaesthetic machine with ventilator and accessories.
Anaesthetic cardiac monitor (CO2 monitor probe) ECG monitor probe BP monitor probe Defibrillator, external automated Automated non-invasive BP monitoring (adult and paediatric) Fluid/blood warmer O2 monitor ETCO2 monitor 167 SERVICE CATEGORY Provincial Hospital National referral Hospital Regional Referral Hospital Temperature monitor Nerve stimulator Rapid IV infusion sets ECG machine (12 lead) Blanket warmer Sterilising and Infection Control Bench top autoclave Surgical instrument washer As for Regional Referral Hospital Ultrasonic washer Steam steriliser Endoscope disinfection/sterilising unit Package sealer Trolleys, trays and racks TBA TBA Biomedical engineering TBA Physio/Rehabilitation Parallel bars As for Provincial Hospital PLUS: As for Regional Referral Hospital Standing frame Exercise steps & stairs Treatment couch Gym equipment Skeletal model Plinth bed with overhead rails Ultrasound machine (treatment) TENS machine 168 SERVICE CATEGORY Provincial Hospital Regional Referral Hospital National referral Hospital Prosthetics/Orthotics TBA Nutrition/dietetics Health education materials Treadmill Patient transfer lift Peak flow meter TBA TBA TBA TBA Health promotion IEC materials As for Provincial Hospital As for Regional Referral Hospital Therapeutic Guidelines for smartphones (eg IMCI) Health Information/Medical Records Computer with internet connection Filing shelves or cabinets Printers As for Provincial Hospital As for Regional Referral Hospital Mortuary Morgue refrigerator, 4-6 drawers Morgue refrigerator, 6 drawers Morgue refrigerator, 8 drawers Mortuary trolley Mortuary trolley Mortuary trolley Autopsy equipment as for Regional Referral Hospital Autopsy carrier with roller Autopsy table, with drainage gutters Hanging autopsy scale Raised dissecting boards platform Examination light (surgical, fixed) EDUCATION, TRAINING, SUPERVISION Telemedicine, clinical consultancy advice.
Videoconferencing system Videoconferencing system Videoconferencing system 169 33 MINISTRY OF HEALTH