Health Centres in Nigeria - Essay Example

BUSINESS PLAN FOR MENTAL HEALTH OR PSYCHIATRIC NURSE LED AMBULATORY SERVICES Contents Contents 2 Executive Summary 3 Background and rational for service development 3 Beneficiary of service development 5 Service Change 8 Clinical effectiveness 11 Distribution of Plan 14 Action Plan 17 Conclusion 19 Appendices 20 References 21 Executive Summary Throughout the study it is found that the number of health centres in Nigeria that provides mental health facility to the Nigerian population is limited and is not able to cover the entire gamut of population. Hence in this context it is found that if the new ambulatory services are introduced it will be a major boon for the Nigerian population. This is in consideration of the fact that the instances of medical illness in increasing amongst the Nigerian population. It is also found that the introduction of the service will prove beneficial for both the population of the country and the organization. This is due to the fact that if the services are introduced then the population will find it easier to access the services. The relatives of the patients will be relieved of the agony that they have to face in taking the patient to the hospital. The introduction of the facility will also result in the fact that the emergency cases will be dealt with more effectively. On part if the organization the benefit lies in the fact that the hospital will be able to save the costs and increase the profitability of the hospital. There are many stakeholders however whose approval is required to successfully implement the plan. Background and rational for service development This study would aim at illustrating importance of mental health services. World Health Organization has worked towards eradicating the problem of mental health. However there are regions such as Nigeria which is lacking appropriate mental health services. In Nigeria there is a high demand towards mental health services. This in turn creates a lot of opportunities for psychiatric nurse led or mental health ambulatory services. The service would be initiated by the Federal Psychiatric Hospital. There is an existing policy in Nigeria known as Mental Health Policy, it was incorporated in 1991. It encompassed wide array of mental health issues along with rehabilitation, promotion, advocacy, treatment and prevention. Over the years there have been no such evaluation techniques incorporated in order to determine effectiveness of the policy. In the health centres, there is always a problem to access required medicines. This forms the basic reason behind developing ambulatory service in Nigeria. There is only 4% of the total government expenditures allocated for mental health services. Mental health facilities in Nigeria and surrounding geographical regions are provided by NGOs. Surveys are conducted across many regions so as to identify potential need of mental health services. In many surveyed locations, non-governmental organizations are not observed to actively indulge into individual assistance. It can be stated that residents of Nigeria or nearby locations desire for customized services during critical scenarios. There is lack of coordinating body who can participate in promotional activities regarding mental health disorders. On the other hand, importance of such service is also closely knitted with designing of a formal structure which can establish link between primary healthcare staff and mental health providers. African countries are observed to be better resourced in terms of wide array of mental health personnel. In current scenario countries are aiming towards expansion of their psychiatrists’ base. Demand towards such innovative services increases only when mental hospitals situated in specific locations are unable to deliver expected service quality level. Officials are in-charge of handling mental health issues along with other primary duties. On the contrary, on catchment basis required health service is not provided to patients and this leads to development of ambulatory services. At ministry level, there is no existence of desk which could manage mental health services. Mental health facilities are also not provided to individuals at distant locations. Adverse impacts of such facilities evolve when necessary service is not provided in given time frame. Nigerian government owns eight mental health hospitals. There are no such differentiated services for adolescents or children. Clinic-based follow up facilities are witnessed in Nigeria and surrounding geographical regions. However outpatient facilities do not have such extended care facilities. Mental health mobile teams are not present in specified location. In the country there are only day treatment facilities available for mental patients. Ambulatory services with nurse and staff members shall facilitate better mental health services. The present facility is only for 20 users and this decreases efficiency level of such services. Community residential services are rarely available in Nigeria. There is a single residential service with ten beds. This creates high potential for ambulatory services. A Psychiatric Hospital in Nigeria was established in 1963. Nervous Disease Clinic was structured later in Uselu (Federal Neuro-Psychiatric Hospital, 2013). There are three buildings in this clinic, providing accommodation to approximately eight in-patients. Outpatient and in-patient services are designed and provided for physical ailments and psychiatric treatment. The need for this service development is inclined towards enhancing accessibility of patients towards such services. Nigerian government allocates limited funds towards mental health services. Hence in this scenario, maintenance of hospital buildings would be costly and it shall initiate demand towards effective ambulatory services. Beneficiary of service development Implementation of mental health service in Africa is basically through district, national and provincial structures. In 1991, mental health policy of Nigeria was formulated. The main target market for this kind of service is individuals possessing psychosocial, mental and neurological disorders. Mental health services are integrated within healthcare facilities. Community residential facilities are not available in Nigeria and nearby locations. Ambulatory psychiatric services shall be provided in order to address such residential facilities. The mobile van facilities would be available for community and also surrounding regions. Patients usually find it difficult to visit hospitals so as to cure their diseases. Work load in hospitals can be reduced through such service development and saved costs can then be allocated to other medical facilities. Psychiatric conditions needs to be handled with care and there is always urgent need towards emergency facilities. Mentally ill patients are considered to be a burden for relatives. On the contrary, if ambulatory services are provided immediately upon call then it shall remove burden of relatives (Staurt and Lavaia, 2001). The agony of relatives can be subdued to a certain extent through enhancing accessibility of mental health facilities. Taking services to the doorstep is a measure through which problems of relatives can be eradicated and expenses can be cut down. The service development in Nigeria shall help many stakeholders. Firstly patients would be benefitted in context of time and money. There is basically sufficient time consumed when patients and their relatives have to travel to mental hospitals. This time can be saved when required services are accessed by target audience at the doorstep. The recovery rate of patients can be improved if ambulatory services are available as and when required. It has been observed that outpatients are not given continuous services and this tends to mental breakdown. Mental illness is a highly sensitive disease which needs to be taken care of properly. Patients shall also benefit in terms of problem faced during searching for beds in mental hospitals. In Nigeria, there is limited number of beds available and it is a major issue for patients and their family members. Governmental authority is responsible for managing hospital operations. However lack of funds results into inappropriate infrastructure facilities. This issue shall be well addressed if mobile van facilities are made available for mental treatment. It would reduce costs incurred by government and also problem associated with bed availability can be efficiently removed (Stellenberg and Bruce, 2007). As per earlier studies, there are specific demographic segments like female users, children and adolescents. Children or adolescents are supplied with mental health facilities and it varies from one location to another. The proportion of adolescent and children users are the highest in case of mental hospitals. These users are treated maximum in these hospitals yielding best possible outcomes. Figure 1 outlines the percentage of children or adolescent who are admitted in medical hospitals from their treatment. Figure 1: Percentage of adolescent or children treated (Source: WHO, 2006) As per figure 1, it is clearly evident that maximum percentage of children or adolescents is treated in mental hospitals. This particular demographic segment is adversely affected by mental diseases. 59% of this group is noticed in mental hospitals, as per current statistics of Nigeria. Percentage of female users who are suffering from mental illness has also increased in recent decade. Figure 2 outlines the percentage increase in this demographic segment. Figure 2: Percentage of female users (Source: WHO, 2006) According to figure 2, females greatly suffer from mental illness due to wide array of factors. There are commonly observed being treated in outpatient facilities, inpatient units and mental hospitals. This clearly indicates that females, children and adolescents are key beneficiaries of the services to be developed. The reasons behind this group suffering from mental illness are excessive pressure, societal conditions, etc. These individuals would have high demand towards ambulatory services. Emergency conditions can be mitigated through such innovative service design. Service Change Nigerian legislation is inclined towards providing superior quality medical facilities to all patients. Over the years there has been various health related issues in Nigeria and other African regions. The growing percentage of mental illness has given rise to development of mental hospitals. In general context, mental treatment is exhibited is in hospitals. The approach of providing mental treatment at the doorstep is a completely new mechanism. It shall prove to be beneficial not only for internal stakeholders but even for external stakeholders. Service change shall mainly be in terms of giving emergency ailment and curing mental disorders of maximum percentage of individuals (Adedotun, 2000). The service to be developed shall be centred towards structuring emergency ambulatory services. Psychiatric nurse led services will be available for patients residing in any community. There has always been a problem of less number of mental hospitals in Nigeria. Allocation of funds or less availability of space has restricted formation of such mental hospitals. Mobile van facilities are readily available for intensive care but aligning this facility with mental illness is a new concept. The psychiatric treatment ambulance shall not only comprise of nurses but even trained staff members. All possible medication and other necessary medication shall be made available in this mobility van. It is all about bringing medical services at the doorstep of patients. This would help in reduction of agony, time and money spent in treatment of mental illness. The business plan is totally based on a van ambulance which could be easily accessed upon a call. A particular phone unit is incorporated within the plan (Sreevani, 2004). This unit shall be held responsible for transferring calls so that ambulance reaches specified destination for an emergency response. The key personnel involved in this type of service delivery are PNO or principal psychiatric nursing officer and SNO or senior psychiatric nursing officer. These nursing officers shall exercise full control over operations taking place in the ambulance van. In this service design, along with patient consultation there shall also be training given to service personnel. Trained personnel would be able to deliver exceptional service quality to target audience. Within a year’s time span this project would be made available for all mentally ill patients. A well structured layout shall be followed in this service delivery process (First and Tasman, 2011). An organized structure would help in providing services in specified time frame. The major resources required in these ambulatory services will be appropriate infrastructural services, technical equipments, trained staff members, medication facilities, etc. Mental health professionals can be located in Nigeria and South Africa. Figure3 highlights the percentage of health professionals in these two regions. Figure 3: Median of mental health professionals (Source: Morrison, 2005) On the basis of figure 3, it can be stated that Nigeria accounts for limited percentage of mental health professionals. Individuals should be properly trained so that they are able to provide required health assistance to patients. Other resources essential for such service development is investment. External stakeholders can be influenced in order to allocate funds for smooth functioning of operations. The outcomes would be measured through gathering feedback from patients and their relatives. Decreased level of mentally ill patients in hospitals shall highlight the growing demand towards ambulatory services. Financial benefits will be in terms of less investment in infrastructural setup. Patients and their family members would also explore financial benefits since their costs towards proper medical treatment will be reduced. Mental hospitals comparatively charge extra money in comparison to such ambulance van. Human resource benefits would also be observed in such service change. There are large numbers of individuals who are employed in mental hospitals like psychiatrists, social workers, doctors, nurses, psychologists, therapists, and other workers. Human resource management is a crucial task for any form of organization. However in ambulatory services, the issues related to managing wide base of individuals can be eliminated (Olatawura, 2002). In this service change, there will be two nursing officers who would be in-charge of treating patients. Hence, entire focus can be shifted towards introducing training programs rather than managing wide array of individuals. The national strategic priority is to enhance well-being of individuals. This was the reason behind formulation of Mental Health Policy in Nigeria. The service development would have a strong relationship with such policy framework. Its main objective is to upgrade the level of emergency response and eradicate completely mental health problems. In the client population, there has been a need identified towards accessing prompt services. Client population is inclined towards limiting expenditure in medical treatment but has a desire towards emergency facilities. This aspect of quick response would be effectively addressed with the support of this service change. Clinical effectiveness The Psychiatry hospital that is present in the Edo State in Nigeria is one of the 8 mental hospitals that are run by the Federal government in the Nigeria. The hospital which had its benign beginnings as a clinic has now turned into a full-fledged mental hospital that is serving the area (Ahrenfeldt and Soddy, 2013). The hospital is renowned for its clean and beautiful environment. The hospital has gigantic facilities by which it provides the patients of the hospitals with the most modern facilities. As per the new business plan it is intended that the hospital wants to open an ambulance service by which nurses of the hospital will be able to reach the outskirts and bring the treatment to the door steps of the clients. The effectiveness of the business plan and the ambulance service lies in the fact that benefit is available to both parties of the facility (Ghodse, 2011). In other words provision of the service will result in a win-win situation for the client as well as the hospital. That is to say that by providing this facility both organizations which will be providing the service and client who will be the recipient of the service will be benefitted to an equal extent. The potential impact that the service will have on both the clients and the organization are given in the following pages. Clients/ Service User: The benefits that the service will bring to the clients or the service user is many fold. The preliminary benefit and the purpose of setting up the ambulatory service is the fact that this facility will help the organization in bringing nursing care to the patients at their doorsteps of the clients (Acton, 2013). This will be a great benefit for the community that the organization faces in the surrounding environment. This will be a great boon for the families of the patients as they will be saved of the trouble of bringing the patients to the hospitals. This will also relieve the stress of the patient families and the patients who bring their relatives to the hospitals. This will also help in the fact that the burden and agony of the relatives who will bring the mentally ill to the hospital will also be reduced. The main advantage of the service for the patient community is the fact that the service will bring the health facility to the door steps of the patient community. This has the added advantage that in case of emergencies and the chance of relapse of the psychiatric conditions treatment can be delivered to the door steps of the patients. The service will be in sort a great boon to the patient community and the clients of the business. The ambulance service will be helpful in the fact that clients or the service user will be relieved of the stress that they have to undergo when they will go to the hospitals. The psychiatric service that the ambulatory service will bring to the community of the neighbourhood area of the hospital will be a great boon to the patient community due to increase in awareness amongst the patient community. The psychiatric condition and problems related to the psychiatric condition has not much awareness amongst the people. Part of the problem also arises due to the difficulty in diagnosis of the problem and the problem of bringing the patients to the hospitals. Thus introduction of the ambulatory service will help in bringing the much needed awareness that is needed in this field amongst the people. Since the service will reach the door steps of the people they will be forthcoming in telling the problem and getting the treatment. This will ultimately result in the fact that the condition of mental illness will get much better chances of being treated. When the relatives of the patients have to bring the patients the hospital they have to face several agonies and troubles. The agonies are related to the fact that it is very difficult to bring such patients to the hospital especially if the condition is very severe. The second factor is related to the huge no. of patients already present in the hospital will lead to the fear psychosis amongst the patients and the families of the patients. Thus introduction of the ambulatory services by the hospital to the neighbourhood community of the hospital will result in the fact that the patient and the relatives of the patients will be saved of this community. Organization: The benefits of the service in case of the organization lies in the fact that workload of hospital would be reduced. This will also led to reduction in expenditure of the hospital on the patient in the form of reduction of the amount of subsidies that the hospital has to spend on the treatments of the clients. The SWOT analysis of the particular service is done in the appendix to understand the benefit that the service will bring to the organization. When the no. of patients who visit the hospitals increases the hospital management finds it difficult to keep cleanliness at the hospital premises. It also helps in the fact that when hospitals start providing health services to the community at their door steps the hospital will be able to gain popularity and the recognition of the hospital will improve. The hospital presently has to provide subsidized service to the patients. When the hospital decides to start the ambulatory services then the cost of providing that service will be reduced. This will result in the fact that the hospital will have to bear less expenditure losses incurred by the hospital is reduced. This is due to the fact that when a patient is admitted to the hospital, the patient has to be allocated a room and will have to be provided with modern facilities. However when the ambulatory services reaches the door steps of the people there is no physical space that has to be allocated to the patient and this will lead to reduction in costs. As the hospital decides to introduce the ambulatory services the reach of the hospital to the farthest corners of the country improves. This will also result in the fact that the no. of patients visiting the hospital will reduce resulting in reduction of the workload of the hospital staff. Distribution of Plan As with any business plan there is certain important existing or future stakeholders who needs to be intimidated about the plan. This is to ensure that the stakeholders may help in setting up the business. There are several benefits that the business will gen by sharing the plan with the clients and the benefits that founders will be getting by sharing the business plan with the different stakeholders is unique. The key stakeholders to whom the business plan will be revealed are: The Minister of Health: The hospital is one of the 8 Psychiatric Hospital that is federally sponsored in the country. Taking this fact into consideration, it is important to disclose the business plan to the minister of health in Nigeria as he is the authority who will either approve or disapprove the plan to introduce the ambulatory services (Lasserre, 2012). If the minister of health is satisfied with the plan and can understand the benefits that the plan will be able to achieve in terms of the benefits that it provides to the neighbouring community then he will release the fund that will lead to the introduction of the ambulatory services. The minister of health may in turn forward the proposal to the finance ministry for the sanction of fund if he feels that it is worthwhile. In order to convince the minister of health it is important to show how the implementation of the service fits into broad target of the government aimed at the particular aspect of health. The Medical Director: The medical director of the hospital is Dr. S. O. Olotu. The medical Director of the hospital is a very important stakeholder in the implementation of the business plan. The business plan of the introduction of the ambulatory services should be approved by the medical director Dr. Olotu as the preliminary step towards the approval and launch of the plan. This is due to the fact that he is the person who will be responsible to further forward the plan to the minister of health. It is for this reason that it is required for medical director of the hospital to be himself convinced of the feasibility and practicality of the plan. To convince the medical director to give his nod for the plan it is important to state the benefits of the plan and the feasibility of the plan to the medical director of the hospital so that he can take the matter with the minister of health. The head of Clinical- The head of the clinical department of the hospital is also an important stakeholder in the approval of the business plan. This is due to the fact that head of the clinical of the hospital will provide the necessary feedback and data regarding the clinical condition (Joshi, 2005). The head of the clinical facility will also give instruction and help in the feasibility study. He or she will be particularly helpful in the fact that he will provide the details of the medicine that needs to be kept in the ambulance. The head of clinical will also give report on the feasibility of the treatment of such patient in an ambulatory service. The particular recommendation by the head of the clinical may be used to identify the type of instruments that needs to be kept ready at hand. The recommendation by the head of clinical may also be useful in determining the special type of training that is to be provided to the nurses delivering the health care. The director of the Nursing services- The director of the nursing services is a very important stakeholder in the implementation of the business plan. This is due to the fact that a fundamental part of the business plan on which the business plan is particularly cantered on is the nurses. The nurses will be required to deliver the services to the community and bringing the services to the door step of the client. The personnel who will be required to deliver the service to the client are PRO or the Principal psychiatric nursing officer and SNO or the Senior Psychiatry Nursing officer with the availability of community nurse. Since Nurses are an important element to the success of the business plan it is required to get approval of the director of nursing services. The director of the nursing services may recommend on the availability of the nurses and the training the nurses should be provided with. The director of the nursing may also provide with the required no. of personnel that will be required to be recruited by the hospitals. Head of Finance: The head of the finance is perhaps the most important stakeholder to whom the business plan is to be narrated. This is due to the fact that whatever may be the structure and aim of the business plan the main thing that drives any business plan for that matter and this business plan in particular is the finance or the funding (Cox and Fardon, 2008). The head of the finance is required to calculate the financial viability of the project and to estimate whether the project is financially sustainable. In calculating the cost benefit ration of the business plan it will be required to compute the benefit that this plan will provide over the present option in respect of the cost that will be incurred in setting up the plan (Shim and Siegel, 2000). Since the project will be incorporated to bring the facility to the remotest corner and the service provider over here is a government run hospital it is important to consider the non financial benefits too that this project or in other words the implementation of the ambulatory services will bring (Lasserre, 2012). The head of the finance will be required to compute the profitability of the project and whether it is sustainable for the hospital to go ahead with the business plan. The equipments that will be required to administer the plan along with the purchase of the ambulance as part of the business will also require approval by the finance head (Keller, 2006). Action Plan Objective Action Required Involved Stakeholders The steps involved Time length Purchase of the van and ambulance along with attached call facility Calling of tender to purchase the machine that is required Finance head, Medical Director, Head of Clinical, and Minister of health. 1. Prepare a selection criterion (Pride and Ferrell, 2014) 2. Calling of the tender 3. Short listing of the ambulances meeting the criterion 4. Giving the order to the selected and successful bidder (Broadbent and Cullen, 2003). 3 months Training to the Personnel Required to decide on the training required Medical Director, Finance head, Head of Clinical, Head of nursing and Minister of health. Evaluate the current qualification of the personnel and identify the training requirement of the personnel. Provide the required training to the personnel so that they can deliver the service effectively 5 months Introduction of the Ambulatory services with the call in facility for the nearby environs Approval of the minister of health and completion of the above tasks All the above mentioned stakeholders Completion of the above steps, Doing feasibility study getting the approval of all the involved stakeholders before introducing the service. 1year Conclusion This business plan is centred towards mental ambulatory services. Mental patients would be given required service in the ambulance and this shall save costs related to medical infrastructure. Mental health policy was formulated in 1991 in Nigeria. Patients through this service facility would benefit in terms of problem related to accessing mental hospitals during emergency. The service that will be provided from the company as part of the ambulance service will help the company in cutting costs. It will also help the patients in the fact that they will be able to receive treatment at remote places.However, there are several weaknesses from which the service may suffer and it is important to use the strengths effectively to overcome the weakness. Appendices SWOT STRENGTH The service will help the hospital in cutting costs. The service will help the patients in receiving the treatments at remote places The service will save the patients and relatives of the agony to visit the hospitals The rising cases of mental illness will be addressed and so will knowledge about the disease increase. The emergency patients will be able to receive quick treatments. WEAKNESS It might be possible to carry out bigger treatments in the hospital Technical fault in the machinery may create a heavier problem particularly in remote area The service might not be financially viable due to rising fuel costs The residents or the patients may not be open to the idea. OPPORTUNITY The rising trend of medical illness in Nigeria The opportunity to provide the services to the farthest places THREAT The government may not approve the plan to introduce the ambulatory services The government may feel there are other areas of health care services that need preliminary attention. References Acton, Q. A. (2013) Mental Health: new insights for the healthcare professional. Georgia: ScholarlyEditions. Adedotun, A. (2000) Basic psychiatry and psychiatric nursing. Ile-Ife: Basag (Nig) Enterprises. Ahrenfeldt, R.H. and Soddy, K. (2013) Mental health in a changing world: volume one of a report on an international and interprofessional study group convened by the world federation for mental health. Oxon: Routledge. Broadbent, M. and Cullen, J., (2003) Managing Financial Resources. Oxford: Butterworth Heinemann. Cox, D., and Fardon, M. (2008) Management of finance. Worchester: Osborne Books. Federal Neuro-Psychiatric Hospital (2013). History. Available at: http://www.psychospitaluselu.com/uselu_new/history.html (Accessed: 12 June 2015). First, M. B. and Tasman, A. (2011) Clinical guide to the diagnosis and treatment of mental disorders. New Jersey: John Wiley & Sons. Ghodse, H. (2011) International perspectives on mental health. London: RCPsych Publications. Joshi, R. M. (2005) International marketing. New York: Oxford University Press. Keller, K. L. (2006) Marketing management. UK: Pearson Prentice Hall. Lasserre, P. (2012) Global strategic management. Singapore: Palgrave Macmillan. Lasserre, P. (2012) Global strategic management. Singapore: Palgrave Macmillan. Morrison, V. M. (2005) Foundations of mental healthcare. Missouri: Mosby Inc. Olatawura, M. O. (2002) Psychology and psychiatry. Ibadan: Spectrum Books Limited. Pride, W. and Ferrell, O.C. (2014) Foundations of marketing. UK: Cengage Learning. Shim, J. K. and Siegel, J. G. (2000) Financial management. London: Barron’s. Sreevani, R. (2004) A guide to mental health and psychiatric nursing. India: Jaypee Brothers Medical Publishers Ltd. Staurt, G. W. and Lavaia, M. T. (2001) Principles and practice of psychiatric nursing. 7th ed. Missouri: Mosby Inc. Stellenberg, E. L. and Bruce, J. C. (2007) Nursing practice medical-surgical nursing for hospital and community. 2nd ed. London: Churchill Livingstone. WHO. (2006) WHO-AIMS report on mental health system in Nigeria [Online]. Available at: http://www.who.int/mental_health/evidence/nigeria_who_aims_report.pdf / (Accessed: 12 June 2015). Read More