Accomplishments ppt.pps
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Transcript of Accomplishments ppt.pps
The Practical Side of Comprehensive Care:
ACCOMPLISHMENTS, CHALLENGES AND
LESSONS LEARNED AT KNH
Dr. David BukusiKenyatta National Hospital
VCT and Comprehensive Care Centers
Comprehensive care
Medical and nursing care• OIs/prophylaxis TB, PCP• ARVs• Palliative care
Psychological support• Adherence counselling • Supportive counselling • Post-Test counselling • Post-Disclosure Group
Therapy • Follow-up counselling
PEP Laboratory support
Youth Friendly services Nutritional support Social worker support
tracing defaulters, family support
Spiritual support Referrals for medico-legal
services Networking CCC network Post-test support groups Children’s group therapy/play
Components of Comprehensive care
COMPREHENSIVE CARE
COMPREHENSIVE CARE IS ABOUT
THE PATIENT
The PATIENT may be able to access several services, preferably under one roof, or service provision area as opposed to having services available and having the patient try to track them down
Introduction HIV/AIDS is not just an infection, it is an
emotional, psychological, physical, spiritual and social problem. Thus it requires a multi disciplinary and multi-sectoral approach.
The KNH CCC centre was opened in December 2002.
Initially CC services were provided at Patient Support Centre but this has recently moved to Rahimtulla Wing of KNH.
KNH CCC is one of the largest in the country.
PICTURE OF KNH CCC
Picture to be included later
KNH CCC PARTNERSHIPS
Comprehensive care is about partnerships
KNH CCC Partnerships USAID (PEPFAR) through FHI CDC/UON (PEPFAR) through ACTS MSH (PEPFAR)
Accomplishments Establishment of the CCC which provides;
• Physical care: ART provision, OI diagnosis and treatment, prophylaxis, Laboratory services (CD4, VL, Biochemistry).
• Emotional care: Pre and post test counseling, anxiety relief, support groups (PTC), ongoing care and counselling.
• Spiritual care: In collaboration with the KNH Chaplaincy.
• Social care: community support / outreach, nutritional support, financial dependence/capabilities, networking.
Accomplishments Number of Patients on Comprehensive Care.
( 170 clients per day, including Children)• No. on ARV’s, OI Prophylaxis, PEP• No. / % on Nutritional support / Nutritional
Counselling
Psychosocial support – counselling, social workers• To inpatients • Outpatients – at CCC, Post Test Clubs.
Graphical Representation of Patient load
Cumulative Number of Patients on ART - 2006
0
200
400
600
800
1000
1200
1400
1600
Cum
ulat
ive
Num
ber
January 920 1392 245
February 972 1456 262
March 1010 1517 280
Male Female Children
Accomplishments
Capacity building • Internal - Health worker training in CC (or
aspects of CC) ART, HBC, CVCT, VCT, DTC, Adherence Counselling .
• External – Technical guidance and supervision to network partners - over 20 VCT / CCC service providers.
• Training of staff from over 10 other large institutions.
• Development and revision of training curricula.
Accomplishments Adherence Monitoring and evaluation. Through;
• Lab;• Follow up – Defaulter tracing. Client assessment;• Data Forms.
Enhanced quality of Care. Has been possible through;• Development of Standard Operating Procedures &
documentation incl. Client Interviews.• Training – CME’s ;• Staff to do ongoing M & E , Quality Assurance and
supervision.
Accomplishments
MIS and IT Services to enhance data collection, data storage, ease drug dispensing and Lab reporting.
Provision of DTC to inpatients.
KNH CCC SERVICES
Referrals forSocial and legal services, wills, inheritance
Peer support, PTC, group therapy
•Spiritual services Homes, community services, hospices
Medical and nursing care
•OIs•ARVs•Palliation
Psychological support•Follow-up counselling•Adherence
Socioeconomic support•Microcredit•Nutrition•OVC
Comprehensive Care for HIV
Challenges High demand for service Lack of adequate Human Resource
to match demand – incl. Child & Adolescent counsellors and care providers.
System challenges • Supplies , complexity of procedures:
Multiple Programmes = different reporting needs / objectives.
• Staff Attitudes
51
64
76
9186
116
141
159
0
20
40
60
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120
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No
. o
f C
lien
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2ndQuarter
2004
3rdQuarter
2004
4thQuarter
2004
1stQuarter
2005
2ndQuarter
2005
3rdQuarter
2005
4thQuarter
2005
1stQuarter
2006
Quarter
Average No. of clients per Day
Average per day
Challenges
Inadequate networking to ensure optimal utilisation of resources• Both internal and external networking (with CBO,
NGO, FBOs, Youth Groups)
Provision of “Comprehensive Care” that is not limited to only ARV provision.
Scaling up Home Based Care. Operationalising SOPs in CC
Challenges
Monitoring and evaluation; • of success of treatment, programme
performance.• of Patient Transfers in / transfers out
Provision of CC to children and adolescents – have special needs.
Challenges
Operationalising MIS and IT for clinical services.
Though cost of drugs is low, cost of diagnosis, CD4, VL, Biochemistry, Haematology e.t.c remains high.• Harmonizing data collection (e.g. for
different operational researches) • Use of gathered information to guide
decisions.
Lessons Learned There is a high demand for quality
Comprehensive Care A multidisciplinary team is necessary for the
CCC concept to be effective. Networking is essential because not all client
needs can be met at one location. Clear concise guidelines and standard
operating procedures are useful in standardising the quality of CC especially where it is provided by many people.
Counseling is the foundation of consistent adherence to therapy and to successful comprehensive care.
Lessons learned
The PATIENT must remain the primary focus
A continuum of care needs to be maintained between different members of the multidisciplinary team for CC to be successful.
Consistent data collection is necessary to enable monitoring and evaluation.
Way Forward Coordinated and joint outreach and
defaulter tracing needs to be strengthened to improve adherence to treatment.
Provision of technical support and guidance to new centers beginning CC is important
– To learn from past mistakes and gain from
experiences learnt.
WAY FORWARD
Enhanced Psychosocial Care and support at the community level must be developed further.
Continued provision of quality service to clients and ensuring of the same through – M&E, SOPs must be implimented
Inclusion of other domains of Comprehensive Care remains a challenge- • Counselling of family and care givers• Legal issues of discrimination, unfair dismissal.• Reproductive health issues of HIV couples etc
Way Forward Better linkage between CCC and in-
patient services to ensure continuity of care when these patients are admitted.
Continued staff development to keep abreast with new technology and methodologies in care provision.
ACKNOWLEDGEMENTS
KNH MANAGEMENT USAID/FHI CDC/UON/ACTS MSH MEDS/PHARMACCESS KNH CCC STAFF
Thank you.