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Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
Ram Shrestha
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Ram Shrestha

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  • 1. Kenya Nutrition QualityImprovement Demonstration ProjectRarieda, Bondo, Siaya & Ugenya Districts Ram Shrestha, Senior Quality Improvement Advisor USAID Health Care Improvement Project University Research Co., LLC February 22, 2012 1
  • 2. FBP sites in Nyanza Province Site status District Total 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
  • 3. Nutrition-HIV Gaps/Challenges 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/breakdownsSources: AIDSTAR Report 2010,Kemri OR- 2010,FANTA review 2007 USAID HEALTH CARE IMPROVEMENT PROJECT
  • 4. Demonstration quality improvement projectObjective:To improve the Quality of Nutrition services at health facilities for PLHIV in Nyanza province USAID HEALTH CARE IMPROVEMENT PROJECT
  • 5. Nutrition/HIV QI sitesSiaya District 1. Siaya District Hospital 2. Yala Sub-District Hospital Ugenya District 4. Ambira Sub-District Hospital 5. Ukwala Health Center Bondo District 7. Bondo District Hospital 8. Got Agulu Sub-District Hospital Rarieda District 10. Madiany District Hospital 11. Ongielo Health Center USAID HEALTH CARE IMPROVEMENT PROJECT
  • 6. QI Approach USAID HEALTH CARE IMPROVEMENT PROJECT
  • 7. The QI process begins by:• Identifying problems• Analyzing Problems• Developing Change Ideas• Testing Change Ideas• Measuring Improvements USAID HEALTH CARE IMPROVEMENT PROJECT
  • 8. Focus on “SYSTEMS’ THINKING” USAID HEALTH CARE IMPROVEMENT PROJECT
  • 9. Model of a systemThe sum of all elements (including processes) thatinteract together to produce a common goalQuality Improvement Inputs Resources necessary to carry out a process USAID HEALTH CARE IMPROVEMENT PROJECT
  • 10. Model for Improvement USAID HEALTH CARE IMPROVEMENT PROJECT
  • 11. Example:QI activities in Bondo District Hospital USAID HEALTH CARE IMPROVEMENT PROJECT
  • 12. Quality improvement approachElements of QI :•QI Teams•Coaches•Regular QI Team Meetings•Testing Improvements (PDSA Cycle)•Participate in Learning Sessions USAID HEALTH CARE IMPROVEMENT PROJECT
  • 13. Bondo DH QI members• Coach, Nutrition Officer • Pharmacist• Social worker • FBP assistant• Clinical officer • Mentor Mother (PMTCT) • Clinical officer (ART)• Nurses• Data• Counselor USAID HEALTH CARE IMPROVEMENT PROJECT
  • 14. QI implementation activities: TimelineBL LS LS LS EL Coaching Coaching Coaching Coaching QI QI QI QI QI QI QI QI QI QI QI QI m m m m m m m m m m m m 1st month 3rd month 6th month 9th month 12th month USAID HEALTH CARE IMPROVEMENT PROJECT
  • 15. Service delivery: 7 steps USAID HEALTH CARE IMPROVEMENT PROJECT 15
  • 16. Improvement objective: Nutritional assessmentand 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
  • 17. PLHIV flow mapping before QI intervention ReceptionCounselling Clinician (hit,wt, Community MUAC)Laboratory Pharmacy FBP USAID HEALTH CARE IMPROVEMENT PROJECT
  • 18. Process map1. Why do you need improvement? 2. What are we trying to accomplish?3. What changes will lead to animprovement? 4. How do we know if there is Process map improvement? Fishbone diagram Desired Performance Tools Inputs Processes Outcome Present Performance USAID HEALTH CARE IMPROVEMENT PROJECT
  • 19. PLHIV patients flow after QI intervention Reception (ht, wt, MUAC) Triage Community ClinicianCounseling Laboratory Pharmacy FBP USAID HEALTH CARE IMPROVEMENT PROJECT
  • 20. Intervention results

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