1. I walked into a rather quiet Rachuonyo patient support centre reception area,
there I spotted my interviewee seated at a corner with a felt pen and a piece of
square like paper in his hands. Benefiting from a closer look, he was writing num-
bers. In a slow and steady mode, he kept counting…51…52…53… then in a com-
posed manner he looked up, straight into my eyes.
“I know it is 4pm. Can we start the interview after 30 minutes? As you
can see I cannot go home now, as I have to plan for tomorrow,” he
said.
David’s narration accounted for two decades of living with HIV. Without malice
and with utmost good faith, he narrates and cites examples of real life stigma and
discrimination he faced while waging through the mucky referrals advised. I must
admit I was a little impatient to discuss quality improvement matters at the facili-
ty and how he engages with the system…and just when I was about to stop him
through a fast forward prompt, he dropped a clue as to why he is working on the
numbers.
Having been a member of the Quality Improvement Team at Rachuonyo, which
looks into Patient Self-Management (PSM) – where health workers and patients
talk about the patient's health needs, and work together to write down goals so
the patient can achieve better health – David quickly related his life experiences
in accessing and utilizing Anti-Retroviral Therapy (ART).
“Every day, I take it upon myself to ensure patient files are prepared a
day before each appointment. Adherence to treatment is very critical,
and it all starts with a patient attending all scheduled visits. These
numbers, help in organizing the flow of patients, thus reducing conflict
among them as they queue for services.”
I inquired to understand the former system, and why the change.
“Previously, patients would place their cards on a table. Due to in-
creased competition to be attended to early, cards were intentionally
switched by unruly patients causing commotion which led to demorali-
zation of some.”
At this point I quickly understood his detailed backgrounding to quality improve-
ment as he related the eventualities to personal experiences.
“Secondly, cards have names, and many patients would feel exposed
when they were called out loudly in the public space. Numbers have
helped reduce such cases that would lead to self-inflicted stigma and
thereafter discrimination. These were the small things that made me
miss many appointments. I would not like anyone to go through such
an experience.”
As I kept looking at David, my mind pondered around a couple of questions… Isn’t
David already practicing aspects of quality improvement at his level of effort?
Didn’t he just do a root cause analysis? Didn’t this skill emanate from the PSM
training of expert patients? Isn’t he already dealing with a potential barrier
(which that is, non-adherence to scheduled visits) to achieving PSM?
Dear Reader, Welcome to your weekly knowledge management and communication e-bulletin. Let us boost our sharing, access and utilization of information on ongoing and upcoming events.
Increasing Patient Retention and Adherence; the Immersion
Experience to Quality Service Provision
24th May 2016 - Circulation 002
Written by: Bill Okaka (Knowledge Management
and Communication Officer). Contributors: Doreen
Bwisa (QI Advisor; Nutrition), and Lindah Chebet
(Assistant M & E Officer).
The views in this publication do not necessarily reflect the opinion and position of URC, USAID, or the MoH. For queries, comments and any other form of feedback, kindly communicate directly to bokaka@urc-chs.com
Generating numbers at his favorite corner. David an expert patient takes lead
in securing a future of people living with HIV. Photo by B. Okaka.