Data for Impact hosted a one-hour webinar sharing guidance for using routine data in evaluations. More: https://www.data4impactproject.org/resources/webinars/routine-data-use-in-evaluation-practical-guidance/
Lessons learned in using process tracing for evaluationMEASURE Evaluation
Access the recording for this Data for Impact (D4I) webinar at https://www.data4impactproject.org/lessons-learned-in-using-process-tracing-for-evaluation/
Seven Steps to EnGendering Evaluations of Public Health ProgramsMEASURE Evaluation
Because international development increasingly focuses on gender, evaluators need a better understanding of how to measure and incorporate gender—including its economic, social, and health dimensions—in their evaluations. This interactive training, consisting of this presentation and a tool, will help participants learn to better evaluate programs with gender components. Access the tool at https://www.measureevaluation.org/resources/publications/tl-19-40
Data for Impact hosted a one-hour webinar sharing guidance for using routine data in evaluations. More: https://www.data4impactproject.org/resources/webinars/routine-data-use-in-evaluation-practical-guidance/
Lessons learned in using process tracing for evaluationMEASURE Evaluation
Access the recording for this Data for Impact (D4I) webinar at https://www.data4impactproject.org/lessons-learned-in-using-process-tracing-for-evaluation/
Seven Steps to EnGendering Evaluations of Public Health ProgramsMEASURE Evaluation
Because international development increasingly focuses on gender, evaluators need a better understanding of how to measure and incorporate gender—including its economic, social, and health dimensions—in their evaluations. This interactive training, consisting of this presentation and a tool, will help participants learn to better evaluate programs with gender components. Access the tool at https://www.measureevaluation.org/resources/publications/tl-19-40
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
Bea Brown gave a presentation on her research for the Sax Institute at the University of Sydney for the School of Public Health's 2013 research presentation day.
Laura Eyre and Martin Marshall: Researchers in residence Nuffield Trust
Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
John Lavis | Making research work for decision makers: international perspect...Sax Institute
Professor John N Lavis, Director of the McMaster Health Forum at McMaster University in Canada, recently addressed a CIPHER forum to share his experience in making research useful for health decision makers.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Warwick Anderson | Research funding perspectives for CIPHER forumSax Institute
Professor Warwick Anderson AM, CEO of the National Health and Medical Research Council, recently addressed a CIPHER forum to share how the NHMRC was testing ways to better match research funding with policy needs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Effectiveness of the current dominant approach to integrated care in the NHS:...Sarah Wilson
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Ruth Thorlby: capturing patient and staff thoughts in evaluation Nuffield Trust
Ruth Thorlby, Acting Director of Policy at the Nuffield Trust, presents reflections on the challenges of capturing patient and staff thoughts in evaluations
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
The Current State of Play of Community Health Workers Training Programs in Su...germainsky
Literature Review, Commissioned of the One Million Community Health Workers Campaign by mPowering Frontline Health Workers, through support from USAID & Intel
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
Bea Brown gave a presentation on her research for the Sax Institute at the University of Sydney for the School of Public Health's 2013 research presentation day.
Laura Eyre and Martin Marshall: Researchers in residence Nuffield Trust
Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
John Lavis | Making research work for decision makers: international perspect...Sax Institute
Professor John N Lavis, Director of the McMaster Health Forum at McMaster University in Canada, recently addressed a CIPHER forum to share his experience in making research useful for health decision makers.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Warwick Anderson | Research funding perspectives for CIPHER forumSax Institute
Professor Warwick Anderson AM, CEO of the National Health and Medical Research Council, recently addressed a CIPHER forum to share how the NHMRC was testing ways to better match research funding with policy needs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Effectiveness of the current dominant approach to integrated care in the NHS:...Sarah Wilson
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Ruth Thorlby: capturing patient and staff thoughts in evaluation Nuffield Trust
Ruth Thorlby, Acting Director of Policy at the Nuffield Trust, presents reflections on the challenges of capturing patient and staff thoughts in evaluations
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
The Current State of Play of Community Health Workers Training Programs in Su...germainsky
Literature Review, Commissioned of the One Million Community Health Workers Campaign by mPowering Frontline Health Workers, through support from USAID & Intel
Postgraduate residency presentation #2 from recruitment to graduationCHC Connecticut
What does the 12-month Nurse Practitioner Residency program look like? This webinar will delve into the details of the structure, design, and content of a 12-month, Federally Qualified Health Center (FQHC) based, postgraduate nurse practitioner residency program. Topics such as recruitment, screening and selection of candidates, core programmatic and curricula elements, and the essential contributions of other staff will be discussed. This webinar will feature speakers from the Community Health Center, Inc.’s first-in-the-nation nurse practitioner residency program and guests from other exemplary programs around the country.
NTTAP Webinar: Postgraduate NP/PA Residency: Discussing your Key Program Staf...CHC Connecticut
Expert faculty will discuss the drivers, benefits, and processes of implementing a postgraduate residency training program at your health center. This session will dive deeper into a discussion on the responsibilities of key program staff, preceptors, mentors, and faculty for successful implementation. This webinar will equip participants with a road map to go from planning to implementation and offer an opportunity for coaching support.
Panelists:
• Program Director of the Nurse Practitioner Residency Program, Charise Corsino, MA
• Clinical Program Director of the Nurse Practitioner Residency Program, Nicole Seagriff, DNP, APRN, FNP-BC
Healthcare organizations in Canada are making great strides in promoting safer patient care through engagement and partnership. Now the best of these organizations would like to share their successes and lessons learned with you!
Full details:
https://goo.gl/NukquA
Innovations in Breastfeeding and Breastmilk Feeding in the NICULeith Greenslade
Can "Lactation Scorecards" drive up low rates of breastmilk feeding in NICUs? Low rates of breastfeeding and breastmilk feeding among sick and vulnerable newborns contribute to low survival rates and poor development outcomes. Medela has developed a new tool that enables NICUs to set new targets and measure their performance - The NICU Lactation Care Scorecard.
Using the government health system to deliver nutrition interventions in Bang...Transform Nutrition
This presentation by Masum Billah, icddr,b was shown at the Transform Nutrition - Evidence for Action regional meeting in Kathmandu, Nepal on 8 July 2017. This one-day event shared Transform Nutrition evidence on key issues related to nutrition policy in Nepal, Bangladesh and India, lessons on strategies for change from other contexts and discuss the relevance and applicability of the research findings to policies/programmes that aim to address nutrition in South Asia.
The engagement of patients and families within the healthcare system at all levels is essential to transformation and renewal. In 2013, Horizon embarked on a journey to become a truly patient and family centred organization. This included engagement of patients and their family members at the front line, as well as within overall system and governance levels within our organization. This discussion will focus upon the tools of engagement which have been developed, challenges encountered and lessons learned as Horizon has sought to move toward greater patient and family partnership to improve quality and outcomes.
Using the health system to deliver nutrition interventions in BangladeshTransform Nutrition
This presentation by Masum Billah, iccdr,b was shown at the Transform Nutrition - Evidence for Action regional meeting in Kathmandu, Nepal on 8 July 2017. This one-day event shared Transform Nutrition evidence on key issues related to nutrition policy in Nepal, Bangladesh and India, lessons on strategies for change from other contexts and discuss the relevance and applicability of the research findings to policies/programmes that aim to address nutrition in South Asia.
Clinical Workforce Development NCA Informational WebinarCHC Connecticut
Learn more about training and technical assistance offered through Community Health Center Inc.'s National Cooperative Agreement (NCA) on Clinical Workforce Development. Hear more about FREE Learning Collaboratives opportunities to enhance or implement a model of Team-Based Care at your Health Center, and how to implement a Post-Graduate Residency program for Nurse Practitioners and Post-Doc Clinical Psychologists.
There are many examples of evidence-informed decision making (EIDM) among public health professionals and organizations in Canada. However, there are limited mechanisms in place to facilitate the sharing of these stories within the public health community. The National Collaborating Centre for Methods and Tools (NCCMT) seeks to address this gap with an interactive, peer-led webinar series featuring a collection of EIDM success stories in public health.
These success stories will illustrate what EIDM in public health practice, programs and policy looks like across the country.
Join us to engage with public health practitioners across Canada as they share their success stories of using or implementing EIDM in the real world. Learn about the strategies and tools used by presenters to improve the use of evidence.
Featuring:
Knowledge broker training for evidence-informed decision making: Building capacity in public health
Lori Greco and Dr. Megan Ward, Region of Peel Public Health
Region of Peel Public Health has identified evidence-informed decision making as a strategic priority, termed End-to-End Public Health Practice. Learn more about how this health unit is building internal capacity for knowledge brokering and evidence-informed decision making.
Making evidence-informed decisions about the Alberta Public Health well-child visit: The art and the science
Farah Bandali and Maureen Devolin, Alberta Health Services
In Alberta, there was decreasing time available for non-immunization well-child clinic visit activities and these activities varied at clinics across the province. Learn more about how these authors used evidence-informed decision making to decide on which routine activities to include in non-immunization well-child clinic activities.
Elective Care Conference: keynote speech from Adam Sewell-JonesNHS Improvement
Outlining NHS Improvement's national priorities and how we'll support providers.The slides accompanied NHS Improvement's Executive Director of Improvement's keynote speech.
Similar to What’s Next?Practical Implementation Lessons from the Partnership for HIV-Free Survival (20)
Managing missing values in routinely reported data: One approach from the Dem...MEASURE Evaluation
This Data for Impact webinar was held in December 2020. Access the recording and learn more at https://www.data4impactproject.org/resources/webinars/managing-missing-values-in-routinely-reported-data-one-approach-from-the-democratic-republic-of-the-congo/
This Data for Impact webinar took place October 29, 2020. Learn more at https://www.data4impactproject.org/resources/webinars/use-of-routine-data-for-economic-evaluations/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
What’s Next?Practical Implementation Lessons from the Partnership for HIV-Free Survival
1. What’s Next?
Practical Implementation
Lessons from the Partnership
for HIV-Free Survival
Emily A. Bobrow
Heather B. Davis
David K. Hales
MEASURE Evaluation
25 September 2019
Webinar
2. Partnership for HIV-Free Survival (PHFS)
• Innovative project designed to prevent and eliminate mother-
to-child transmission of HIV (PMTCT and eMTCT)
• Brought together proven practices from PMTCT, quality
improvement (QI), nutrition, and community outreach to
improve health outcomes for mothers living with HIV and their
HIV-exposed infants
• Supported by USAID and PEPFAR, PHFS was active
between 2012 and 2016 in six countries in sub-Saharan
Africa: Kenya, Lesotho, Mozambique, South Africa, Tanzania,
and Uganda
3. PHFS evaluations by
MEASURE Evaluation
• PHFS Legacy Evaluation Report
https://www.measureevaluation.org/resources/publications/tr-18-314
• Country-Specific Briefs
Kenya: https://www.measureevaluation.org/resources/publications/fs-18-251
Lesotho: https://www.measureevaluation.org/resources/publications/fs-18-250
Mozambique: https://www.measureevaluation.org/resources/publications/fs-18-293
South Africa: https://www.measureevaluation.org/resources/publications/fs-18-266
Tanzania: https://www.measureevaluation.org/resources/publications/fs-18-249
Uganda: https://www.measureevaluation.org/resources/publications/fs-18-255
• Outcome Evaluation of PHFS in Uganda
4. Intended users of the guide
• People who are keenly interested in improving the
performance of PMTCT/eMTCT programs and related
activities (e.g., retention in antiretroviral therapy
[ART])
• People with different expertise, including advocacy,
policy, planning, oversight, and implementation
5. Many combinations
• Conception of the guide originated from the PHFS
evaluations by MEASURE Evaluation
• PHFS approach was successful in many facilities
across the 6 PHFS countries, but not all approaches
were the same
• Explored how facilities were successful
• Conceptual image of a stew
o Baseline ingredients required
• Minimum number of baseline ingredients
o Recipes can differ
o Circumstances and availability of ingredients is important to consider
o Need to end up with a well-balanced, nourishing stew using your
winning recipe
6.
7. “How-to” guide
• Practical information
• Designed to be flexible, so countries can identify and take
advantage of opportunities in their existing systems to shift
toward the PHFS approach
• Can take an incremental approach to implementation; not
required to do everything at once
8. Format of the “how-to” guide
• Key lessons from PHFS
o Short descriptions, definition of terms, tips
o Three main areas:
• Service delivery
• Quality improvement
• Community engagement
• Checklists
o Preparing to implement the PHFS approach
o Launching the PHFS approach
o Sustaining the PHFS approach
o Extending the PHFS approach
9. Key lessons from PHFS
1. Mother-baby pairs
2. Mother-baby clinics
3. Integrated services
4. Nutrition
5. Quality-improvement tools and techniques
6. Coaching and mentoring
7. Knowledge exchange
8. Community workers
9. Metrics and data sets
10. Mother-baby pairs
• What
o Mothers living with HIV and HIV-exposed infants are seen together at the
same appointment
• Why
o More efficient approach leading to better outcomes for mother and baby
• How
o One appointment for mother-baby pair
o Combined records
o Recommending joint appointments for as long as possible
o Continued dialogue with the mother
11. Mother-baby clinics
• What
o Mother-baby pairs are seen at designated mother-baby clinics
• Why
o Stigma reduction
o Less travel time and waiting time for mothers
o Establishment of relationships with peers including participation in formal
and informal support groups
o Health facility improvements in quality of care and support
• How
o Designated time and date—be consistent
o Possibly designated space for a mother-baby clinic
12. Integrated services
• What
o All relevant and/or required services are available to mother-baby pairs at
each visit to the mother-baby clinic
• Why
o Efficient and more-effective visits
o Better satisfaction contributing to better retention in care
• How
o Map how services are currently delivered
o Propose changes to integrate services
13. Nutrition—Breastfeeding
• What
o Changing breastfeeding beliefs and practices among mothers living with
HIV
• Why
o Benefits of breastfeeding for the baby and the mother are high
o Risk of transmitting HIV through breastmilk is extremely low when
mothers living with HIV are on ART
• How
o Health facility staff need to consistently communicate the current
breastfeeding recommendations
14. Nutrition Assessment,
Counseling and Support (NACS)
• What
o NACS activities, including breastfeeding practices, are available to
mother-baby pairs as a component of integrated services
• Why
o Pregnant women and mothers who are living with HIV and HIV-exposed
babies will have better health outcomes if they are properly nourished
• How
o Ensure NACS is an integral part of PMTCT programming
o Consider having a nutritionist at district level and at health facilities
15. Quality-improvement
Tools and techniques
• What
o Basic, facility-led quality improvement practices
• Why
o Improvement of facility performance and outcomes for mother-baby pairs
• How—specific tools and techniques
o QI teams
o Change ideas
o QI journals
16. Coaching and mentoring
• What
o Coaches and mentors provide regular support to frontline staff to
implement the overall PHFS approach, including QI activities
• Why
o Coaching has been shown to solidify PHFS-related outcomes through
supporting frontline staff to implement QI
o Coaches provide a level of quality control to the QI activities
• How
o Hands-on support and instruction to supplement training
o Work directly with frontline staff
o Consistent, frequent visits lead to success
17. Knowledge exchange
• What
o Frontline staff share knowledge and experience with colleagues at other
facilities, to learn from each other and continue to improve their program
• Why
o Efficient and cost-effective way to improve performance and outcomes
• How
o Formal knowledge exchange
• Quarterly review meetings
• Staff exchange visits
• Organized sessions with multiple facilities
• Webinars and conference calls
o Informal knowledge exchange
• Encouraging sharing ideas in day-to-day work environment
18. Community workers
• What
o Community workers, including peer mothers, conduct outreach work to
support retention in HIV care and treatment for mother-baby pairs.
• Why
o Creating and maintaining productive relationships with patients plays a
significant role in retention of mother-baby pairs
• How
o Capitalize on different cadres
• Community health workers, peer mother organizations, family support groups, support
groups for people living with HIV (PLHIV)
o Ensure community health workers have basic counseling skills
o Foster partnership between facility and community
o Tracing for loss to follow-up
o Develop a compensation plan for community health workers
19. Metrics and data sets
• What
o Appropriate and practical metrics and data sets to track and improve the
performance and outcomes of PMTCT programs
• Why
o Facility staff are invested in their own data and in making real-time
changes to improve services and retention
• How
o Identify metrics that will generate useful and useable data
o Frontline staff should be consulted on core metrics
o Revisit metrics over time to ensure relevance
• E.g., Tracking indicators with stable performance may not be needed, or a core
indicator like retention might be retained for quality assurance purposes
20. Additional considerations
• Reducing the burden of primary data collection
o Data collection is so cumbersome that it reduces the time for patient care
o 3 ways to reduce the burden
• Limit the number of indicators
• Streamline the process
• Increase staffing levels
• Leveraging the lessons and effectiveness of the PHFS approach
o Extending PHFS approaches to general ART centers could have a
positive effect on broader ART retention among PLHIV
• Potentially starting with mothers living with HIV transferring back to these centers at
the end of the PMTCT cycle
21. “How-to” guide
• Key lessons from PHFS
• Checklists
o Preparing to implement the PHFS approach
o Launching the PHFS approach
o Sustaining the PHFS approach
o Extending the PHFS approach
22. Checklist #1
1. Planning and approval
2. Site selection
3. Community partners
4. Technical assistance
5. Services
6. Quality improvement practices
7. Performance metrics and data sets
8. Coaches and mentors
9. Knowledge exchange
10.Tools and training
Preparing to launch the PHFS approach
23. Checklist #1
SITE SELECTION
2.1. Develop a core set of selection criteria
2.2. Use the criteria to identify facilities for PHFS
2.3. Conduct a rapid assessment to determine
capacity and readiness/willingness
2.4. Use the results to select facilities to implement
PHFS activities
2.5. Work with managers and staff at the selected
facilities to plan the launch of the PHFS
approach
Preparing to launch the PHFS approach
EXAMPLE
24. Checklist #1
SITE SELECTION
2.5. Work with managers and staff at the selected facilities to
plan the launch of the PHFS approach.
Issues to address include:
An initial facility plan to identify where and when the mother-baby clinic
could operate
A preliminary staffing plan that matches qualified and available staff with
different PHFS activities.
A basic assessment of areas where technical assistance may be required
to effectively launch these activities (e.g., service delivery, QI,
counselling, community outreach, nutrition, data collection/quality/use)
A basic budget to implement the PHFS approach, including any up-front
costs (e.g., facility refurbishment) and specific recurring costs that are not
covered by the facilities existing operating budget (e.g., funding for
outreach workers)
Preparing to launch the PHFS approach
EXAMPLE
25. Checklist #2
11. Human resources
12. Clinic logistics
13. Operations
14. Outreach education
15. Messaging
16. QI tools and techniques
Launching the PHFS approach
26. Checklist #2
OPERATIONS
13.1. Designate PHFS clinic days and times
13.2. Agree on mother-baby services
13.3. Set up mother-baby pair appointment
system
13.4. Set up mother-baby pair tracking system
13.5. Set up a coordination system
• Ensure consistent and complementary information,
guidance, and support to mother-baby pairs
13.6. Set up mother-baby pairs tracing system
13.7. Establish a positive, patient-centered
atmosphere
Launching the PHFS approach–EXAMPLE
27. Checklist #2
OPERATIONS
13.4. Set up a simple record keeping system that can
keep track of pairs, including the critical information for
both mothers and babies (e.g., height/length & weight,
growth monitoring, ART regimen, infant HIV test,
mother’s viral load testing)
• This system is likely to be an informal modification or workaround to
an existing record keeping system (e.g., patient cards and registers)
• Ensure staff have ready access to patient information for both mother
and babies at every appointment
Launching the PHFS approach–EXAMPLE
28. Checklist #3
17. Human resources
18. QI tools and techniques
19. Coaching and mentoring
20. Knowledge exchange
21. Patient input
Sustaining the PHFS approach
29. Checklist #3
HUMAN RESOURCES
17.1. Assess integrated staffing plan for frontline workers
17.2 Assess the knowledge and skills of frontline staff and their
managers
17.3 Consult with frontline staff about their job satisfaction
• Workload
• Patient interactions
• Knowledge and skills
• Coaching and mentoring
• QI practices
• Management and compensation
Sustaining the PHFS approach–EXAMPLE
30. Checklist #3
17.1. At least two times per year, assess the
integrated staffing plan for frontline workers,
including facility-based and community-based staff
Talk directly with frontline workers about the strengths and
weaknesses of the staffing plan and possible ways to
improve the plan
Consult with coaches and mentors about the strengths
and weaknesses of the staffing plan and possible ways to
improve it
Use the basic QI tools and techniques to identify ways to
improve the staffing plan and the related issues
Implement identified improvements
Sustaining the PHFS approach–EXAMPLE
31. Checklist #4
IDENTIFYING AND EXPLORING NEW OPPORTUNITIES
22.1 Identify groups in health facilities implementing the PHFS
approach
22.2 Discuss with managers and staff
22.3 Plan for who will be involved and how
22.4 Discuss how the approach will be adapted
22.5 Ensure process is collaborative
22.6 Review elements of the checklist that apply to this
effort
Extending the PHFS approach–EXAMPLE
32. Checklist #4
22.1. Identify departments, centers, and/or programs in health
facilities implementing the PHFS approach where the approach
could be adapted to improve performance and outcomes
Consult with frontline staff who are using the PHFS approach about
departments, centers, and/or programs that could implement an adapted
version of the approach
Initial assessment of these opportunities should be done at the facility level,
where frontline staff have the best perspective on where and how to adapt
the PHFS approach within their facility
Existing management structures are likely to require facilities to get
agreement/sign-off from a higher level (e.g., district or above)
Extending the PHFS approach–EXAMPLE
33. Conclusion
• Designed to be flexible, so countries can identify and
take advantage of opportunities in their existing
systems to shift PMTCT programs toward the PHFS
approach
• Takes an incremental approach to implementation;
not required to do everything at once
• Practical information in two sections
• Key lessons from PHFS
• Checklists
34. This presentation was produced with the support of the United States Agency
for International Development (USAID) under the terms of MEASURE
Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE
Evaluation is implemented by the Carolina Population Center, University of
North Carolina at Chapel Hill in partnership with ICF International; John Snow,
Inc.; Management Sciences for Health; Palladium; and Tulane University.
Views expressed are not necessarily those of USAID or the United States
government.
www.measureevaluation.org