Kenya Nutrition QualityImprovement Demonstration         ProjectRarieda, Bondo, Siaya & Ugenya Districts   Ram Shrestha, S...
FBP sites in Nyanza Province                         Site status        District                                 Total    ...
Nutrition-HIV Gaps/Challenges 1.   Overstay in the program 2.   High drop out rates 3.   Food storage considerations 4.   ...
Demonstration quality improvement projectObjective:To improve the Quality of Nutrition services at health  facilities for ...
Nutrition/HIV QI sitesSiaya District   1. Siaya District Hospital   2. Yala Sub-District Hospital   Ugenya District   4. A...
QI Approach     USAID HEALTH CARE IMPROVEMENT PROJECT
The QI process begins by:• Identifying problems• Analyzing Problems• Developing Change Ideas• Testing Change Ideas• Measur...
Focus on “SYSTEMS’    THINKING”        USAID HEALTH CARE IMPROVEMENT PROJECT
Model of a systemThe sum of all elements (including processes) thatinteract together to produce a common goalQuality Impro...
Model for Improvement           USAID HEALTH CARE IMPROVEMENT PROJECT
Example:QI activities in Bondo   District Hospital           USAID HEALTH CARE IMPROVEMENT PROJECT
Quality improvement approachElements of QI :•QI Teams•Coaches•Regular QI Team Meetings•Testing Improvements (PDSA Cycle)•P...
Bondo DH QI members• Coach, Nutrition Officer   • Pharmacist• Social worker              • FBP assistant• Clinical officer...
QI implementation activities: TimelineBL               LS                  LS                 LS                     EL Co...
Service delivery: 7 steps            USAID HEALTH CARE IMPROVEMENT PROJECT                               15
Improvement objective: Nutritional assessmentand categorization of all clients at every visit• Indicator for the objective...
PLHIV flow mapping before QI intervention                   ReceptionCounselling     Clinician (hit,wt,          Community...
Process map1. Why do you need improvement?              2. What are we trying to                                          ...
PLHIV patients flow after QI intervention                   Reception                (ht, wt, MUAC) Triage                ...
Intervention results
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Ram Shrestha

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Ram Shrestha

  1. 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. 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. 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. 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. 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. 6. QI Approach USAID HEALTH CARE IMPROVEMENT PROJECT
  7. 7. The QI process begins by:• Identifying problems• Analyzing Problems• Developing Change Ideas• Testing Change Ideas• Measuring Improvements USAID HEALTH CARE IMPROVEMENT PROJECT
  8. 8. Focus on “SYSTEMS’ THINKING” USAID HEALTH CARE IMPROVEMENT PROJECT
  9. 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. 10. Model for Improvement USAID HEALTH CARE IMPROVEMENT PROJECT
  11. 11. Example:QI activities in Bondo District Hospital USAID HEALTH CARE IMPROVEMENT PROJECT
  12. 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. 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. 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. 15. Service delivery: 7 steps USAID HEALTH CARE IMPROVEMENT PROJECT 15
  16. 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. 17. PLHIV flow mapping before QI intervention ReceptionCounselling Clinician (hit,wt, Community MUAC)Laboratory Pharmacy FBP USAID HEALTH CARE IMPROVEMENT PROJECT
  18. 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. 19. PLHIV patients flow after QI intervention Reception (ht, wt, MUAC) Triage Community ClinicianCounseling Laboratory Pharmacy FBP USAID HEALTH CARE IMPROVEMENT PROJECT
  20. 20. Intervention results

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