3. Out lines
• Back ground
• Problem identification
• Data source
• Problem prioritization
• Problem statement
• Aim statement
• Root cause analysis
• Driver diagram
• Change ideas
• PDSA cycle
4. Back ground
• Woin amba health center is found in Amhara
regional state south wollo zone legehida woreda.
• Estimated population
Male =10727
Female =10900
Total =21627
Expected pregnancy = 729
5. S.N Name Position Responsibility Remark
1 Sani Endris Bsc nurs Head of HC Chair
person
2 Ager Endris mw MW focal
3 Tshay assun HIT HIT focal
4 Yowredanos webet HO Tekenice head
5 Anetneh menegsha HO NCD focal
6 Mohammed dawed nurs HEW focal
6. Definition of quality
• The degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge.
• Comprehensive care that is measurably safe,
effective, patient-centered, and uniformly
delivered in a timely way that is affordable to the
Ethiopian population and appropriately utilizes
resources and services efficiently.
7. Identified problems
Low Early ANC coverage (37 % )
Low skilld delivery coverage(62%)
Low PNC coverage (62%)
• New born car withen one hour 80%
• AMTSL 80%
10. Problem statement
Based on our baseline assessment on DHIS2
report in the last one year from oct 2012 E.c
to sep 2013 E.C at WHC we found low early
ANC coverge <16 week which is around 37% it
leads to Abortion maternal death and
neonatal congenital anomalies. It will be
resolved when ANC at 60%.
11. Aim statement
• We Wein amba health ceneter quality
improvement group aims to improve Early
ANC coverage from 37% to 60% from
DEC/2013 to Jun 30/2013 E.C
12. Low early
ANC
coverage
community
Leadership Health staff
Fiancé Data
Low community
awareness
HAD Not well functional
HDAs and 1/5 not
aware the community
and no’sort
HEW No HH visit
HEW not motivated
HC 1/5 and mw not
support
• Poor staff
motivation
• Poor management
skills and feed back
• not moniter and
evalute HEW focal
not well informed &
evaluated at kebele or
HC levele
No register
Poor documentation
Lack of budget
1.Lack of supply
Under report
13. increase
Early ANC
coverage
37% - 60%
community
Health
facility
community
awareness
health facility visit
For educate &
counseling
Quality of care
Providing HE to mothers at
kebele level.
functional & utilize HDA
structure
facility & community
supervision
Providing training to HEW and
HDA how to educate the
community
outcome
Primary Driver
Secondary Driver
Change Ideas
accessibility of
supply
Training in MNH protocol and
CRC at all health settaf
Monitor essential commodities
gaps e,g HCT,Hgt,durge
,other
Clean, safe, &
attractive
Facilities increased CASH performance
14. Change ideas
1. Providing HE to mothers at kebele level
2. Providing training to HEW and HDA how to educate the
community
3. functional & utilize HDA structure
4. facility & community supervision
5. Training in MNH protocol and CRC at all health settaf
6. Monitor essential commodities gaps
7. increased CASH performance
15. Prioritization Matrix
S.N Problem
Magnitude
of
the
problem
cost
Community
concern
Feasibility
of
intervention
Total
scor
Rank
1 Providing HE to mothers at kebele level
5 4 4 5 18 1
2 Providing training to HEW and HDA how
to educate the community 5 5 3 4 17 2
3 functional & utilize HDA structure
4 0 4 5 13 4
4 facility & community supervision
3 2 2 3 10 6
5 Training in MNH protocol and CRC at all
health settaf 5 5 3 3 16 3
6 Monitor essential commodities gaps
5 4 3 5 17 2
7 increased CASH performance
2 3 4 3 12 5
*Rating Scale used: 0-5
16. Selected Change ideas
1. Providing HE to mothers at kebele level
2. Providing training to HEW and HDA how to educate the
community
3. Training in MNH protocol and CRC at all health settaf
4. Monitor essential commodities gaps e,g HCT,Hgt,durge ,other
17. OUT COME MEASURE
percentge of Pregnant mothers attended early ANC
PROCESS MEASURES
number of mothers educated
number of HEW trained
number of HDA functinal
number of facilities supervisions
proportion of essential commodities gap
percentage of CASH
Number of Training in MNH protocol and CRC at all health settaf
BALANCING MEASURES
percentage of institutional delivery
Proportion of neonatal & maternal complication
Proportion of neonatal & maternal death
percentage of PNC coverage
percentage of data qulity
Percentage of client satsefaction
18. Change ideas Indicators
1/Providing HE to mothers at kebele level
Percentage of mothers educated = Total No. of Mothers educated x 100
Total Mothers Expected
2/Providing training to HEW and HDA
Percentage of HEW and HDA trained = Total No. of HEW and HDA trained x 100
Total No. of HEW and HDA Expected
3/Training in MNH protocol and CRC at all health settaf
Total No of health settaf = total no of health train settaf x100
total no all sttaf
4/ Monitor essential commodities gaps=not indicator
19. PDSA cycle
• Problem- low early ANC coverge
• OVER ALL AIM- To increase early ANC coverage of wein amba
health ceneter from 37 % to 60 % from Decber 1 /2013 to June
30/2013 E.C
• Problem analases-using fish bone diagram
• PDSA AIM –To increase early ANC coverage of wein ameba
health ceneter from 37 % to 50 % from Decber 1 /2013 to feb
30/2013 E.C
• Providing training to HEW and HDA
• PREDICTION -We expect more than we planned if we
perform our change ideas properly
21. change idea action plan
no
Activities
Who is
responsible
When will it
happen
Where
will it
happen
How it will be
performed
1 All keble womens 1/5 and
HDA arregemenet
HEW
Keble leaders
Female leader
15/4/2013 E.C Keble arrangement will
be all women's in
keble prepared by
Keble leader and
HEW
2 Bejute allocetede for
trininge
Head of HC
Werda Health
office
20/4/2013 E.C HC Training will be
given for be jut
allocated for tea
sermons and
payment, other
3 Tringe in all women in
keble level and keble leder
Head of HC and
woerda H.office
MW focal person
30/4/2013 E.C HC Training will be
given for HEW and
HDA
4 Moniter and evalution for
HDA and HEW
HC management
or PMT team
MW focal person
1/5/2013 E.C HC Every month
23. Problem statement
In the last year 2012 E.C, only 61% of clients
was attended for institutional delivery in
woin ameba health ceneter through DHIS2 base
line data assessment it leads to neonatal and
maternal death. It will be resolved when
skilled delivery at 85%.
24. Aim statement
• We woin ameba health ceneter quality
improvement team aims to improve skilled
delivery coverage from 61% to 85% from
Decber 01/2013 to Jun 30/2013 E.C
25. Low
Delivery
coverage
community
Leadership Health staff
Data
Low community
awareness
l
Low participation of Pregnant
women conference
1.for Facility visitors not
educate & counseling
•
• Skill gap & commitment
Poor recording
and docemet
2.Low quality services
Skill gap & commitment
Kebele leaders & HDAs are
not Involved properly
Low M&E System
Improper data
analysis
Skill gap & commitment
Skill gap & low
commitment of staff
Health Facility
Financé
Luck of budget
1.Shortage of
ambulance cervices
2. Shortage of
waiting room
supply
1.Low referral linkage
b/n HAD &Hp
Lack of commitment
And not monthly
conferes
NO”t CRC
26. increase
Delivery
coverage
61% - 85%%
community
Health
facility
Effective Pregnant
women
conference
Review & trained Kebele
Leaders ,HDA, & HEW at
woreda
Participate partners & other all
Key participants
Extend no.of pregnant
women conference site
Improve quality of
care Training in Key MNH
national Protocol
Availability of
skilled and respect
full staff
Inco rage Morning cession &
on site training
Improve
availability of
Ambulance
Allocate budget Fore fuiel
&service
Community
engagement for
Awarness creation
outcome
Primary
Driver
Secondary
Driver
Change Ideas
27. Change ideas
1. Review & trained Kebele Leaders ,HDA, & HEW
at HC
2. Allocate budget for pregnant women conference &
delivery service
3. Improve maternal waiting area
4. Regular pregnant women conference
5. Provide Training for midwife on Key MNH national
Protocol and CRC
28. Change ideas for test
1. Review & trained Kebele Leaders ,HDA, & HEW
at HC
2. Regular pregnant women conference
3. Provide Training for midwife on Key MNH national
Protocol and CRC
29. OUT COME MEASURE
Skilled delivery
PROCESS MEASURES
Number of HEW,HAD Kebele leader reviewed
Number of midewife trained
Number of pregnant women conference session done
BALANCING MEASURES
neonatal & maternal complication
neonatal & maternal death
percentage of SK/D and PNC coverage
30. Out come Measure
• Percentage of women's Attend Delivery = Total No. of Mothers Attended sk/d x100
Total mothers Expected delivery
31. Change ideas Indicators
1.Review & trained Kebele Leaders ,HDA, & HEW at HC
Percentage of review meeting = Total No conducted x 100
Total no expected
2. Regular pregnant women conference
Percentage of conference session = Total session conducted x 100 or
Total sessison Expected
Percentage of pregnant women attended = total attended x100
Total expected mother/ total pregnant women
3. Provide Training for midwife on Key MNH national
Protocol
Percentage of midwife train= total trained x100
Total no midwife
32. CHANGE IDEAS
A. Review & trained Kebele Leaders ,HDA, & HEW
at woreda
B. Regular pregnant women conference
C. Provide Training for midwife on Key MNH
national Protocol
PREDICTION -We expect more than we planned if we
perform our change ideas properly
33. Activities
activities Who is
responsible
When will it
happen
Where will
it happen
How it will be
performed
Review &
trained Kebele
Leaders ,HDA, &
HEW at HC
HC & QI
team
From
30/04/2013
HC Review meeting will
be given for Kebele
Leaders ,HDA, &
HEW at HC
Regular pregnant
women
conference
QI team & HC
and HEW
monthely
contenues
kebele conference will be
given for pregnant
mother at kebele by
preparing manual
Provide Training
for midwife on
Key MNH
national Protocol
and CRC
HC & QI
team
From
28/04/2013
HC other
NGO &
woreda
Training will be given
for midwife at woreda
level by preparing PPt
Expectation : If we implement change idea properly , we expect > our aim
35. Problem statement
In the last year 2012 E.C, only % of clients
was attended for early PNC in woin amba
health center through DHIS2 base line data
assessment it leads to neonatal and maternal
death. It will be resolved when PNC at 85%.
36. Aim statement
• We woin ameba health center quality
improvement team aims to improve early PNC
coverage from % to 85% from dec 01/2013 to
Jun 30/2013 E.C
37. ROOT CAUSE ANALYSIS
Low PNC
coverage
community
Leadership Health staff
health Facilita Data
Low community
awareness
l
Low participation of Pregnant
women conference
1.for Facility visitors not
educate & counseling
•
• Lack of commitment
lack of skilled and respect
full staff
Poor recording
Kebele leaders & HDAs are
not Involved properly
Low M&E System
Improper data
analysis
Skill gap & commitment
Skill gap & low
commitment of staff
Turn over of skilled staff
1.Low referral Linkage
b/n HC &HP
Lack of commitment
2.Poor quality service
38. increase
PNC
coverage
67 % - 85 %
community
Health
facility
Effective Pregnant
women
conference
Extend no.of pregnant women
conference site
Participate partners & other all
Key participants
Orient kebele leaders &
HDAs
Improve quality of
care
Improved referral
linkege
Availability of
skilled and respect
full staff Inco rage Morrniring cession
& on site training
Out come
Primary
Driver
Secondary Driver
Change Ideas
39. Change ideas
1. Discussion & provide orientation for all staffs
2. Provide adequate counseling regularly to every clients by
midwifes on importance of 24hr post delivery admission.
3. Arrange additional room for PNC and allocate more beds at
postnatal room
4. Assign additional staffs for PNC services
5. Review completeness of the patient data at PNC Chart &
register by using an audit tool
6. Conduct Regular weekly internal mentorship
40. Change ideas for test
1. Discussion & provide orientation for all staffs
2. Provide adequate counseling regularly to every
clients by midwifes on importance of 24hr post
delivery admission.
3. Review completeness of the patient data at PNC
Chart & register by using an audit tool
41. OUT COME MEASURE
mothers attended early PNC
PROCESS MEASURES
Number of staff oriented
Number of mothers counseled
Percentage of patient data seen
BALANCING MEASURES
neonatal & maternal complication
neonatal & maternal death
42. Out come Measure
• Percentage of women's Attend early PNC = Total No. of Mothers Attended PNC x100
Total mothers Expected sk/delivery
43. Change ideas Indicators
1. provide orientation for all staffs
Percentage of staff oriented = Total No. of staff oriented x 100
Total Expected staff
2. Provide adequate counseling regularly
Percentage of mothers counseled= Total No. of mothers counseled x 100
Total No. mothers Expected
3. Review completeness of the patient data Total
percentage of patient data= total no patient data seen x100
Total sample data taken
44. PDSA cycle
• OVER ALL AIM – To increase early PNC
coverage of from 67 % to 85 % from DEC 1/2013 to
June 30/2013 E.C
• PDSAAIM –To increase early PNC coverage of
woin ameba health cenetre from 67 % to 85 % from
DEC 01/2013 to Jan 30/2013 E.C
45. Activities
activities Who is
responsible
When will it
happen
Where will
it happen
How it will be
performed
Review & trained
Kebele Leaders ,HDA,
& HEW at woreda
HC & QI team From 30/04/2013 HC Review meeting will be given
for Kebele Leaders ,HDA, &
HEW at HC
Regular pregnant
women conference
QI team & HC and
HEW
monthly continues kebele conference will be given for
pregnant mother at kebele by
preparing manual
Provide Training for
midwife on Key MNH
national Protocol
HC & QI team From 28/04/2013 HC other
NGO &
woreda
Training will be given for
midwife at woreda level by
preparing PPt
Data collection HC & QI team From 30/04/2013 HC Review meeting will be given
for Kebele Leaders ,HDA, &
HEW at HC
Expectation : If we implement change idea properly , we expect > our aim
