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Strengthening Referrals and Integration of Community and Facility Health Services through Quality Improvement

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The Strengthening Ethiopian Urban Health Program (SEUHP) program aims to improve the health status of the urban population in Ethiopia by reducing HIV/TB-related morbidity and mortality, and by reducing the incidence of communicable and noncommunicable diseases. SEUHP fosters strong community involvement and is working to improve health service delivery through PDSA approach. Their current study found that participatory engagement of community and health center staff, and regular learning process increases referral, feedback and integration of community and facility based health services.

This was presented at the 2018 IHI Africa Forum on Quality and Safety in Healthcare in Durban, South Africa in February.

Published in: Health & Medicine
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Strengthening Referrals and Integration of Community and Facility Health Services through Quality Improvement

  1. 1. Strengthening ReferralsandIntegration ofCommunity andFacilityHealthServices through Quality Improvement ​Yonas Yilma ​Durban, South Africa ​February 20, 2018
  2. 2. BACKGROUND  Strengthening Ethiopian Urban Health Program (SEUHP) is funded by USAID and implemented by John Snow, Inc.(JSI)  Support the Ethiopian Health extension program in 49 major towns  In August 2015 , SEUHP in collaboration with the local health office piloted QII in Jinela HC in Harar town.  QI initiative intend to improve referral feedback and linkages between facility-based primary health services(HC) and community- based health extension program (UHEP)  Implement model for improvement using a PDAS approach through establishing QI team (QIT)
  3. 3. 1. Discuss with the stakeholders: Includes the regional health bureau, city/town health office, and health center management 2. Form QI team: Consist of HC staff, urban health extension professionals (UHE-ps), and UHE- ps supervisors and led by HC head. 3. Capacity building: Provide training on basics of QI 4. Implement: QIT Identify and prioritize improvement objectives, identify and analyze root causes the problem, plan and execute interventions 5. On-the-job support and follow up: Support the QI team as they implement QI plan 6. Monitor implementation: Hold review meetings to assess the progress, and what’s working well; re-plan and set improvement objectives as needed IMPLEMENTATION STEPS
  4. 4. QIT support and follow up Fish bone analysis for prepared by QI team for the identified problem. QI Monitoring Visit by SEUHP staff
  5. 5. INTERVENTION  Piloted in Jinela HC in August 2015  Improvement objective: To increase referral feedback from 43% to 90% over seven months.  Major interventions include:  Conducted baseline assessment and developed action plan  Provided orientation for HC staff on QII  Avail file folder at each department for filing of referral and feedback slips  Referral feedback's collected weekly  QIT meet monthly and review the progress  HC staff provided supportive supervision and coaching for UHE- ps  Facilitated experience-sharing visit  Organized team building events and provided certificates of recognition
  6. 6. IMPROVEMENTS OBSERVED  The mean average of referral cases increased from 7 to 32.9, an increase from the baseline of more than four folds  As of April 2016, four HCs in Harar are implementing QI interventions and promoting collaborative learning  The quarterly average of referred cases and feedback increased by 4.1 (104 to 428) and 2.5 (99 to 227) times from the baseline, respectively  QII motivates clients to take referral slips and value their importance, believe the HC become more welcoming, and encourages acceptance of UHE-ps services by community the and HC staffs.
  7. 7. 7 20 27 39 40 33 28 43 3 13 25 38 38 31 27 41 0 10 20 30 40 50 Aug'15 Sept'15 Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 Mar'16 The trend in the number of referral and feedback in Jinela Health Center, QII pilot, HararTown Total ≠ of referal Total ≠ feedback 43% 65% 93% 97% 95% 94% 96% 95% 90% Aug'15Sept'15 Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 Mar'16 Percent of referral feedback % of referral with feedback Goal Line (90%)
  8. 8. 104 321 283 607 500 99 268 173 294 274 0 100 200 300 400 500 600 700 Jan-Ma'16 Apr-Jun'16 Jul-Sep'16 Oct-Dec'16 Jan-Ma'17 The trend in the number of referral and feedback of 4 HCs since QII scale up in Harar town Referral Referral Feedback 3 HC Added
  9. 9. LESSONS LEARNED  The QIT creates an opportunity for UHE-ps integrate and work as a team with HC staff  Commitment, team spirit, and ownership of the QIT are vital for success  Clients are more motivated to take referral slips and started valuing the referral  Functional QIT motivated UHE-ps to do more
  10. 10. NEXT STEPS  Work with the FMOH to prepare community-based quality improvement implementation guide  Arrange advocacy meeting at all levels to align the QI initiatives with the government’s priorities  Engage the quality improvement process owner/team already established at the regional level  Strengthen review meetings, experience sharing, and recognition of the best performing QIT
  11. 11. THANKYOU YonasYilma yonas_yilma@et.jsi.com This project is made possible by the support of the American People through the United States Agency for International Development (USAID).The contents of this presentation are the responsibility of John Snow Inc. (JSI) and do not necessarily reflect the views of USAID or the United States Government.

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