Clinical Training on Electrocardiograms for the Ministry of Health Palestinian Health Sector Reform and Development Project

Agency for International Development (USAID), designed and implemented in close collaboration with the Palestinian Ministry of Health (MOH). The Project's main objective is to support the MOH, selected non-governmental organizations, and selected educational and professional institutions in strengthening their institutional capacities and performance to support a functional and democratic Palestinian health sector able to meet its priority public health needs. The Project works to achieve this goal through three components: (1) supporting health sector reform and management, (2) strengthening clinical and community-based health, and (3) supporting procurement of health and humanitarian assistance commodities. The Project provided 19 ECG machines to the MOH; nine units for PHC clinics in the Nablus and Salfit Directorates, and 10 were given to five MOH hospitals (Rafidia, Alia, Jenin, and Jericho). To address the objectives of this consultancy, the following stages were identified: STAGE ONE, which included ECG interpretation courses conducted at northern West Bank districts Nablus, Jenin, and Tubas districts for PHC physicians, and bedside coaching for nurses on ECG tracing. STAGE TWO involved attending medical clinics with PHC physicians to identify candidates for ECGs, establish a diagnosis, proper ECG results documentation, filing of ECG, and proper disposition of patients. Nurses' training was delivered via on-the-job coaching and hands-on activities. The results of the previous stages were refined and the enhancement process began through individual site visits to follow, explain, and discuss the Project's intention to cooperate for enhancing the level of care provided and standards of care. The training targeted nurses and doctors, and addressed proper placement of ECG electrodes, use of the machines, as well as interpreting ECG results. The main objectives of this consultancy can be summarized by the following: to enhance the capacity of General Practitioners (GPs) and nurses working at the PHC directorate level and in the Champion Communities to properly utilize ECG machines, to improve the ability of GPs working at the PHC level to interpret ECG results, and to link ECG utilization with the relevant parts of the Standards of Care. The methods used include hall lectures for GPs on ECG interpretation, site visits to assist GPs to identify and select patients who are in need of ECG, and on-site nursing coaching on how to use and properly maintain the ECG machines. The training on the proper ECG utilization at the PHC level should aid in easing the burden on the MOH secondary healthcare level. The following recommendations are for MOH medical directors in each district: improve ECG filing and documentation system, carry out site visits for follow-up, carry out simple preventive maintenance of the ECG machine, and ensure that all ECG machines are being used and utilized to the maximum. The following recommendations are for the NCD coordinators in each district: ensure comprehension and implementation of the course content, start ECG courses, start formulating a plan to expand care services, improve ECG knowledge and interpretation skills, and plan to start ECG Training of Trainers courses. The consultant also provided on-the-job coaching (OJC) as per the Standards of Care (SOC) at clinics, specifically ECG service for patients with non-communicable diseases (NCDs). The training targeted nurses and doctors, and addressed proper placement of ECG electrodes, use of the machines, as well as interpreting ECG results. The main objectives of this consultancy can be summarized by the following: to enhance the capacity of General Practitioners (GPs) and nurses working at the PHC directorate level and in the Champion Communities to properly utilize ECG machines, to improve the ability of GPs working at the PHC level to interpret ECG results, and to link ECG utilization with the relevant parts of the SOC.