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

1. Assessment of the Quality of
Care for Hospitalized Children in
6 Provinces of Afghanistan in
2008
Presenter: Dr Najibullah Hamid

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. 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. 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. Geographic Location
12 hospitals (1 PH and 1 DH per pr
province) in the following provinces:
•Takhar
•Mazar
•Ningarhar
•Paktya
•Bamyan
•Herat

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. 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. 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. 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. 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. 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. 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. Thank you