Ram Shrestha
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Transcript of Ram Shrestha
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Kenya Nutrition Quality Improvement Demonstration
ProjectRarieda, Bondo, Siaya & Ugenya Districts
Ram Shrestha, Senior Quality Improvement AdvisorUSAID Health Care Improvement Project
University Research Co., LLC
February 22, 2012
USAID HEALTH CARE IMPROVEMENT PROJECT
FBP sites in Nyanza Province
District
Site statusTotal
Primary SatelliteBondo 1 8 9Gucha 1 0 1
1 4 5Kisii 2 5 7Kisii Central 1 0 1Kisumu 6 14 20Kuria West 1 0 1Migori 3 29 32Muhoroni 1 0 1Nyando 3 11 14Rachuonyo 2 6 8Rongo 0 1 1Siaya 2 25 27Suba 1 15 16Yala 1 5 6
Total 28 121 149
USAID HEALTH CARE IMPROVEMENT PROJECT
1. Overstay in the program
2. High drop out rates
3. Food storage considerations
4. Sharing of food
5. Nutrition assessment
6. Need to address malnutrition
7. Nutrition counseling and education
8. Data capture and reporting
9. Supply Chain disruptions/breakdowns
Nutrition-HIV Gaps/Challenges
Sources: AIDSTAR Report 2010,Kemri OR- 2010,FANTA review 2007
USAID HEALTH CARE IMPROVEMENT PROJECT
Demonstration quality improvement project
Objective:
To improve the Quality of Nutrition services at health facilities for PLHIV in Nyanza province
USAID HEALTH CARE IMPROVEMENT PROJECT
Nutrition/HIV QI sites
Siaya District1. Siaya District Hospital 2. Yala Sub-District HospitalUgenya District4. Ambira Sub-District Hospital5. Ukwala Health CenterBondo District7. Bondo District Hospital8. Got Agulu Sub-District HospitalRarieda District10. Madiany District Hospital11. Ongielo Health Center
USAID HEALTH CARE IMPROVEMENT PROJECT
QI Approach
USAID HEALTH CARE IMPROVEMENT PROJECT
The QI process begins by:
• Identifying problems
• Analyzing Problems
• Developing Change Ideas
• Testing Change Ideas
• Measuring Improvements
USAID HEALTH CARE IMPROVEMENT PROJECT
Focus on “SYSTEMS’ THINKING”
USAID HEALTH CARE IMPROVEMENT PROJECT
Model of a system
Resources necessary to carry out a process
Inputs
The sum of all elements (including processes) that interact together to produce a common goal
Quality Improvement
USAID HEALTH CARE IMPROVEMENT PROJECT
Model for Improvement
USAID HEALTH CARE IMPROVEMENT PROJECT
Example: QI activities in Bondo
District Hospital
USAID HEALTH CARE IMPROVEMENT PROJECT
Elements of QI :
•QI Teams
•Coaches
•Regular QI Team Meetings
•Testing Improvements (PDSA Cycle)
•Participate in Learning Sessions
Quality improvement approach
USAID HEALTH CARE IMPROVEMENT PROJECT
Bondo DH QI members
• Coach, Nutrition Officer
• Social worker
• Clinical officer (PMTCT)
• Nurses
• Data
• Counselor
• Pharmacist
• FBP assistant
• Mentor Mother
• Clinical officer (ART)
USAID HEALTH CARE IMPROVEMENT PROJECT
QI m
QI m
QI m
QI m
QI m
QI m
QI m
QI m
QI m
QI m
QI m
QI m
BLCoaching
12th month
QI implementation activities: Timeline
CoachingCoaching Coaching
ELLSLSLS
1st month
3rd month 6th month 9th month
USAID HEALTH CARE IMPROVEMENT PROJECT
Service delivery: 7 steps
15
USAID HEALTH CARE IMPROVEMENT PROJECT
Improvement objective: Nutritional assessment and categorization of all clients at every visit
• Indicator for the objective: No. of clients assessed and categorized
• Numerator: Clients assessed
• Denominator: Clients visiting the PSC /CCC
• Data source (Numerator) – BMI/Z-score book
• Data source (Denominator)- Appointment diary
USAID HEALTH CARE IMPROVEMENT PROJECT
Laboratory
Reception
Counselling
Pharmacy
CommunityClinician (hit,wt, MUAC)
FBP
PLHIV flow mapping before QI intervention
USAID HEALTH CARE IMPROVEMENT PROJECT
Process map
1. Why do you need improvement? 2. What are we trying to accomplish?
3. What changes will lead to an improvement?
Process map
Fishbone diagram
Tools
Inputs
Present Performance
Desired Performance
Processes Outcome
4. How do we know if there is improvement?
USAID HEALTH CARE IMPROVEMENT PROJECT
Reception(ht, wt, MUAC)
Triage Community
Clinician
Pharmacy
FBP
LaboratoryCounseling
PLHIV patients flow after QI intervention
Intervention results