Assessment of the Quality ofCare for Hospitalized Children in 6 Provinces of Afghanistan in             2008       Present...
Objectives and Approach• Collaborative effort—shared experience• Peer recognition and review• Refine the assessment tool a...
Process• Preparing Tools and Documents (Jun  2008)  – Finalize questionnaires & guidelines  – Translate questionnaires & g...
Process…• PHI assessments in provinces (July 2008)  – Train assessors and supervisors  – Assessments in provinces  – Analy...
Geographic Location12 hospitals (1 PH and 1 DH per prprovince) in the following provinces:•Takhar•Mazar•Ningarhar•Paktya•B...
Assessment Priority Areas• Triage• Hygiene and infection control• Availability of emergency and first line  drugs• Availab...
Methodology of Assessment• Direct observation• Review of chart/record/monitoring reports/  discharge Instructions• Checkli...
CONTENT OF 14 MODULES•        PARTICIPATORY HOSPITAL ASSESSMENT—Modules•   Module 1: Pediatric Patient Statistics•   Modul...
Results of Hospital Assessment• 1500 input points considered with the  assessment tool• They were summarized into approxim...
Results of Action Planning             Workshop• four “Areas of Focus” were identified as common  areas of weakness among ...
Results of Action Planning          Workshop…• Areas in need of attention that would require  outside support from stakeho...
Recommendation for          assessment tools• The ideal hospital assessment tool would in  theory be comprehensive without...
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Assessment of the Quality of Care for Hospitalized Children in 6 Provinces of Afghanistan in 2008

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Assessment of the Quality of Care for Hospitalized Children in 6 Provinces of Afghanistan was carried out in 2008.

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Assessment of the Quality of Care for Hospitalized Children in 6 Provinces of Afghanistan in 2008

  1. 1. Assessment of the Quality ofCare for Hospitalized Children in 6 Provinces of Afghanistan in 2008 Presenter: Dr Najibullah Hamid
  2. 2. Objectives and Approach• Collaborative effort—shared experience• Peer recognition and review• Refine the assessment tool and process• Provide ownership and commitment to the project• Identify priority needs and interventions• MAKE IMPROVEMENTS
  3. 3. Process• Preparing Tools and Documents (Jun 2008) – Finalize questionnaires & guidelines – Translate questionnaires & guidelines – Prepare job aids for training and data collection• Testing – Train assessors for testing in Kabul – Testing in Kabul – Incorporate Changes
  4. 4. Process…• PHI assessments in provinces (July 2008) – Train assessors and supervisors – Assessments in provinces – Analysis and prioritization workshop • Action planning workshop (August 2008) • Process conducted by MoPH with the technical and financial support of BASICS and TechServ
  5. 5. Geographic Location12 hospitals (1 PH and 1 DH per prprovince) in the following provinces:•Takhar•Mazar•Ningarhar•Paktya•Bamyan•Herat
  6. 6. Assessment Priority Areas• Triage• Hygiene and infection control• Availability of emergency and first line drugs• Availability of treatment Guidelines/Resources• Management of emergency and common conditions
  7. 7. Methodology of Assessment• Direct observation• Review of chart/record/monitoring reports/ discharge Instructions• Checklists• Questionnaires• Presentation of theoretical case scenarios• Formal and Informal staff interviews• Formal and Informal caretaker interviews
  8. 8. CONTENT OF 14 MODULES• PARTICIPATORY HOSPITAL ASSESSMENT—Modules• Module 1: Pediatric Patient Statistics• Module 2: Layout of Hospital• Module 3: General Staffing• Module 4: Support Systems• Module 5: Emergency Care—5 cases (Triage, Airway and breathing, Circulation and shock, Convulsion and coma, Severe dehydration, Severe malnutrition)• Module 6: Children’s Ward—10 cases (Cough/difficulty breathing, Fever, Diarrhea and dehydration, Meningitis and sepsis, Severe malnutrition• Module 7: Supportive Care—10 Cases for Observations• Module 8: Patient Monitoring—5 Cases for review and 5Caretakers for Interview• Module 9: Newborn Nursery/Maternity—5 Cases for Review• Module 10: Case Management of Sick Newborns and Neonates—5 Case Observations and review of 5 Patient Records (from prior admissions).• Module 11: No Module• Module 12: Discharge—Review of 5 patient charts and Interview of 5 Caretakers• Module 13; Mother and Caretaker Involvement—Observations of 5 patients with Caretaker Interview• Module 14: Child Friendly Services—Review of 5 Patients with Caretaker Interview• Module 15: Access and Referral: Interviews with 5 Caretakers and 3 staff (Ed orOPD)
  9. 9. Results of Hospital Assessment• 1500 input points considered with the assessment tool• They were summarized into approximately 100 Performance summary scores – Compilation sheet – Problem sheet • Important areas concerning hospital service and design, as well as lack of clinical guidelines identified • Results presented to action planning workshop
  10. 10. Results of Action Planning Workshop• four “Areas of Focus” were identified as common areas of weakness among most of the hospitals: – Emergency pediatric care – Sick newborn care – Infection control/hygiene – Support/monitoring• Two major systems identified for affecting positive change: – Systemic oversight of staff duties – Expanding and strengthening hospital based and supervised training conferences
  11. 11. Results of Action Planning Workshop…• Areas in need of attention that would require outside support from stakeholders – Policy decision (by MOPH) – Technical guidance (training and systems) – Resource support—particularly in terms of staffing issues
  12. 12. Recommendation for assessment tools• The ideal hospital assessment tool would in theory be comprehensive without being exhaustive• The current assessment tool be further refined in terms of design, language and instructions• The model require further field testing• It needs to be used as three or four different activities, identified as, “Areas of Focus,” in order to keep it manageable and utilize it in a sequential manner for any given hospital
  13. 13. Thank you

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