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Writer's pictureChristian Andrianasolo

THE MICRO-PROJECTS APPROACH TO RENOVATING HEALTHCARE INFRASTRUCTURES.

In 1998, the Ministry of Health decided to launch an infrastructure Programme to support the National Health Policy, financed by the European Development Fund. The aim was to build drug storage facilities (LEMs), then to rehabilitate basic health facilities (CSBs) and other hospital infrastructures (CHDs, etc.). The implementation strategy adopted was to delegate responsibility for rehabilitation and construction to local managers, including doctors. Given the complexity of this type of implementation, the European Union Delegation suggested that the Ministry of Health delegate the management of construction and rehabilitation to our Executing Agency, given our experience developed when implementing the micro-projects programmes.


The Ministry then identified 120 CSBs (basic healthcare facilities), 8 PhaGDIS (wholesale pharmacies managed at district level), 34 LEM (drug storage facilities), and other infrastructures, namely: C.F.S.S.P.C. Befelatanana, D.D.D.S. d'Androhibe, D.I.R.D.S. Nanisana, École d'Enseignement Médico-Social Antananarivo.


We were faced with various challenges.


Quantify materials.

We had to estimate the amount of materials needed for each site, then organize joint purchasing and transportation to the site. We then selected potential suppliers of materials (e.g. cement, iron, sheet metal, etc.) and steelwork. (e.g. for reinforced door).


Organize efficient supply circuits.

The next step was to define efficient supply routes. Then select and contract carriers.

The aim was for each truck to serve several locations. This meant managing supplier delivery times, so that the truck could leave with the right goods at the right time. This was not always easy, as we were dealing with large companies as well as craftsmen. Added to this were the difficulties associated with the roads themselves: distance, road conditions... and sometimes trying to anticipate the weather, as most of the sites were only accessible by small tracks.


Secure supplies.

Each doctor is then responsible for his materials once they have been delivered. This person is also responsible for securing the materials and, above all, for ensuring their proper preservation until they are used on site. For example, ensuring that cement is protected from humidity and bad weather. To this end, we have prepared a how-to for their use. Doctors don't necessarily have experience of site management.


Manage construction sites.

The doctors are directly responsible for their respective worksites. However, by mutual agreement with the Ministry of Health, and in order not to overburden the doctors' workloads, we still proceeded with the selection of site service providers (masons, stonemasons, etc.). For example, for a given site, we tried to find contractors who had performed tasks satisfactorily on a micro-projects project in the surrounding localities. For example, we would recruit masons and carpenters who had successfully completed the construction of a school in the neighboring municipality (by consulting our database). In this way, we ensure not only the quality of the work, but also the control of labor and costs.


Supervise construction sites.

For site supervision, the doctors are supported by technicians who act as site supervisors and quality controllers. Once again, they are selected based on criteria like those used to select the supervisors.


Support implementation.

In addition to the above-mentioned services, we also had to organize site visits to ensure that the project was running smoothly, and above all to check the quality of the work carried out and the conformity of the declared costs.

Our team had also made improvements to the plans, both in terms of efficiency and architecture, to comply with the rules of art and good taste.




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