-successfully meets criteria of services agreement with MoH
Regional Health Authorities (RHAs) were conceptualised to have the organizations run in a more professional and businesslike manner, where persons are held accountable for the delivery of health care. CEO of the Berbice Regional Health Authority, Dr. Vishwa Mahadeo, yesterday informed the Chronicle that, based on the success of the RHA in Region six, other health authorities will be set up across the country. The Ministry of Health will then be the policy-making body that will manage health service provision in the country through the RHAs, which will be accountable to the Ministry for delivery of health care services.
The Berbice Regional Health Authority consists of five hundred and thirty-seven members of staff, who serve in several departments, among which are the administrative, medical, and ancillary departments. This organization is managed by a Board of Directors and a management team comprising of a Chief Executive Officer and four Directors.
Recognising that, as providers of health care services, the Authority is constrained to maintain and improve the health of the people and to reduce the ravages of diseases, the organisation, in order to achieve maximum desired quality of service, has developed a list of code of ethics to guide all health care providers and to ensure that delivery of quality health care services are maintained.
Initially the organization was staffed with four medical doctors and three dental surgeons, who were required to serve all five hospitals and twenty-six health centres and health posts.
Facilities were limited to a laboratory that did only a few lab tests (CBC, urine analysis, and RBS), an X-ray Department that was often without films or reagents, and regular shortages of drugs and medical supplies.
Previously there was maternal mortality of 7 deaths per year (47 per 10,000), which was the highest in the country, as was the infant mortality. Also there were few or no medical outreaches to the hinterland communities.
However, the system currently boasts a staffing component of forty-nine doctors and four dental surgeons. Some doctors are now tasked with the responsibilities of managing the health centres and health posts throughout the region. Dental services are now available at all the hospitals and some health centres. The approach to health care delivery that the Authority in Region 6 has taken has catalysed a dynamic turnaround in the provision of optimum quality health care to the Region.
The approach of the Authority is new and innovative and the ‘exceptional’ service provided by this re-structured system has resulted in all projected targets being surpassed, especially with the integration of all aspects of health, with particular focus on the practice of healthy lifestyles.

Three-year Business Plan, Vision, Goals, and Mission Statement
Strategising new methodologies has paid dividends, with a new three-year Business Plan developed (2010 – 2012).  This was done in a democratic manner after consultations with the staff. This follows the first three-year Business Plan (2007 – 2009). The mission, vision and goals from the previous Business Plan will be reintegrated, since they remain the same.  However, targets are set based on previous performances and the national data.
The Services Agreement is signed by the Minister of Health and the Board Chairman on a yearly basis.
The RHA6 Vision is “A Healthy Berbice Community confident in their Local Health Services”, while its Mission Statement is “To put communities’ health needs first and to deliver a caring service in a courteous and professional manner. We will provide the highest quality health service that Guyana has to offer.” The stated goals of the RHA6 are to: “Develop and implement a system for population-based planning to meet the needs of the population responsively; Strengthen management and utilization of scarce resources; Improve ‘services delivery’ in line with community health needs and within national protocols; and Develop and implement a clear strategy for the management of the National Psychiatric Hospital and in line with the National Mental Health Plan.”
The genesis of the RHA6 was in 2006, when legislation was passed and signed into law to establish Regional Health Authorities as semi-autonomous bodies. A pilot RHA was set up in Region 6 with a Board of Directors and a management team.
Targets were incorporated in the services agreement, as dictated by the legislation that binds the RHA to delivering quality services to the public.

Obstetrics and Gynaecology Department
Tables below illustrate the targets in the services agreement and actual accomplishments for the year 2009.

In the Obstetrics and Gynaecology Department, the PMTCT programmes have been fully implemented in the region, delivering favourable results – 99% of our mothers tested for HIV and all whom were tested positive are on management. Additionally, a daily census is collected as a measure to avoid double occupancy of beds in the ward.
Also, each live birth in the hospital is examined by a paediatrician.
One hundred and Fifty eight caesarian sections were done at the New Amsterdam Hospital (NAH), which is 8% of total deliveries.  Maternal deaths must be reported to the Ministry of Health within 24hrs.  A thorough investigation is then conducted to determine the cause of death.
Doctors and nurses at the hospitals and HC’s were trained and/or upgraded in ALARM workshops, with the intention of providing a better obstetrical service, while two doctors from New Amsterdam and Skeldon Hospitals have been trained in Cryotheraphy.
The services agreement signed with the MoH was adhered to and the RHA reported against the services agreement three times – in the first quarter, at half-year and year end. The RHA met all the criteria and surpassed over 95% of the targets set in the services agreement.
According to CEO, Dr. Vishwa Mahadeo, the RHA cannot cure all the ills nor rebuild all the structures, clear all the drains, and staff all the institutions at optimum levels in a relatively short time span, because it does not have enough funds to do all the developmental works in the health facilities that are required. However, the RHA has managed to maximize the funds that were available to the Authority through a lot of strategising and community participation.
Among the many achievements, to date, of the RHA are a $50 million upgrade to the National Psychiatric Hospital com
plex, making it a place where patients can begin to receive quality health care.
From the budgetary allocation for Region Six, $67M was spent to rehabilitate health facilities across the region. The BRHA has managed to do rehabilitation works in the hospitals, health centres and health posts in the region, including Orealla, CWC, Bush Lot, Brothers, Nurses’ Hostel, Port Mourant pharmacy, the doctors’ quarters, among others.
For 2009, $10.8M was spent on maintenance of interrelated health infrastructure – this includes construction of access roads, repairs to fences, repairs of bridges, et cetera, at various locations; while $18M was spent on the purchase of equipment and furniture for health facilities. This excludes equipment that was supplied from the Central Ministry. These were distributed throughout the region as needed.
This huge investment in buildings, infrastructure and equipment was supplemented by an increase of medical personnel to Region Six. Of the 60-odd 2009 graduates from Cuba, Region 6 received the services of sixteen.
The BRHA, in collaboration with the Ministry of Health, also increased the scope of its training programme and is currently training twelve Pharmacy Assistants in Berbice. During this month the Authority will be starting a Psychiatric Patient Care Assistant Programme, which is a special programme tailored to meet the kind of needs of that institution.

Medical outreaches by medical teams, including doctors, dentists and VCTs
Thirty-seven outreaches were done in several communities, which include Orealla, Siparuta and Bara Cara, Mara, and Yakusari.
Specialist outreaches to the Skeldon Hospital continues (orthopedic and surgical) on a twice-weekly basis. Medical and psychiatric clinics, started in the last quarter of 2008, continue. Outreaches, which include medical, dental, psychiatric care, continue at the New Amsterdam Prisons.
Home visits to patients who suffered fractures to hips and femurs and are immobilized in bed are done by the orthopaedic team, and medexes continue to visit Mara/Scepmod, Yakusari, Sandvoort and Brothers on a regular basis, while a doctor is assigned to Yakusari.  A medical team visits Mara/Scepmod and Brothers on a monthly basis, starting in the last quarter of 2008 and, in 2009, at least once every month, there was an outreach to the area.
In November of last year, the entire Orealla and Siparuta communities were screened for HIV/AIDS. An entire medical team had visited the area and offered the HIV/AIDS rapid test as a part of a health package, which include blood pressure and blood sugar tests, talks on the practice of healthy lifestyles, among others.
Some achievements recorded by the RHA are regular outreaches to hinterland Areas, visits to and management of bed-ridden patients in the Orealla, Siparuta and BaraCara communities.
Patients with illnesses that require specialist management were referred to the New Amsterdam Hospital.
Only recently, on the 15th of April 2010, a new community programme was launched by the BRHA to further meet the medical and related health needs of the people and to improve the quality of healthcare offered in the Region. The aim of the Authority is to visit all bed-ridden patients and to develop a database to better monitor their improvement and need for revisits. The nurses covering each catchment area bear the responsibility of doing routine visits and delivering medication right to the homes of patients between visits by the medical team.
At the Skeldon hospital there are specialist outreaches, where the orthopaedic surgeon, obstetrician gynaecolgist, the general surgeon, medical internist and psychiatrist hold weekly clinics. Monthly clinics are also done at the N/A Prisons. This initiative is to alleviate the suffering of the patients by minimizing or eradicating altogether the need for the patients to visit the NAH to see the specialist.  Instead, the specialist goes to their locations.
All 25 health centres and health posts under the management of the BRHA function well and most of the staff, under the management of SHV, Terry Davis, went beyond the call of duty to achieve an immunization coverage of over 98% in Region 6 for 2009.

Region 6 awarded the Best performing MCH programme in the country for 2009.
Dr. Mahadeo has commended the MCH staff of the RHA, who manage the programme in Region 6.  He said that doctors are now attached to the health centres, which serve as a further boost to public health care, and that patients are given the opportunity to meet with physicians within the close proximity of their homes.
Achievements of the Authority include staff being trained in diabetic foot care – a number of persons in the community were trained by the health workers in this area; health centres now have doctors assigned; vaccination and breastfeeding weeks were observed – the BRHA health fair was used to launch the week of activities; all midwives attached to the MCH department were trained in ALARM; Staff attached to the health centres were all trained in the use of the new WHO growth chart; sprinkles are being distributed to infants, aged 6 – 24 months, at every health centre across the region, with ongoing surveillance and weekly reports being submitted to the department.
According to Dr. Mahadeo, the BRHA measures performance based on the feedback at face-the-community meetings, where members of the various communities are provided the opportunity to air their views and concerns.  So far the Authority has had Face-the-Community meetings at Skeldon hospital, CWC H/C, Orealla HC, Siparuta H/P, No.47 HC,  No.64 HC, Bush Lot HC, Williamsburgh, Mibicuri Hospital and HC and Yakusari HP, Bohemia HC, Cumberland HC, NAFHC. These meetings were well attended and fruitful.
Management committees were set up at these facilities and a larger one at the Skeldon Hospital. There is also a well-established complaints department that deals with and investigates all complaints. In 2009,530 complaints were dealt with. Of these 529 were resolved and one is referred for further investigation.
Special projects were also successful, with the Basic Nutrition Programme witnessing the reduction of severe malnutrition in the region. All mothers and eligible children received sprinkles as a supplement in a timely manner.
The HIV project was a huge success.  In excess of 11,000 persons were tested during the National week of testing in 2009.  Berbicians have thus been sensitized and they now quite responsibly take the test.
Dr, Mahadeo says that the work and business plans of the RHA are in accordance with the National Health Strategy for 2008 to 2012. The priorities of the sector in 2010 continue to be expanding and upgrading of infrastructure to increase coverage and access, enhancing the human resources capability of the sector as a whole, and improving quality in the delivery of publicly guaranteed health services, with emphasis on such areas as family health, chronic, communicable, and non-communicable diseases.
Considerable progress has been made in expanding mental health programmes in 2009, with psychiatric clinics now being held in Skeldon. The programme advanced with training aimed at strengthening and building capacity. The mental health programme also expanded with the establishment of substance abuse programmes in the New Amsterdam prisons, and the New Amsterdam, Skeldon and Mibicuri Hospitals.
Major works are slated to be done at the Skeldon hospital to the tune of $23 m. This will improve the delivery of Health Care to the residents of the area.
The BRHA recently held its 7th Award ceremony. This is to give recognition to members of staff who were exceptional in the performance of their duties. The BRHA has also managed to create a strong support network with the NGO’s, FBO’s and business entities. The Organisation’s award ceremony, held in February, was sponsored by GT&T and the prizes of a trip each for 2 couples to Kaieteur were funded by GT&T. Trips for 8 couples to Mainstay Resort
were funded by Meditron!