2012 somsa congress, st georges, tshwane 04 december 2012 mrs otty mhlongo pmtct manager - kzn
DESCRIPTION
A continuous quality improvement(CQI) approach directed at improving HAART initiation for eligible pregnant women in the province of Kwa- Z ulu N atal, South A frica. 2012 SOMSA CONGRESS, ST GEORGES, TSHWANE 04 DECEMBER 2012 Mrs Otty Mhlongo PMTCT Manager - KZN. - PowerPoint PPT PresentationTRANSCRIPT
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A continuous quality improvement(CQI) approach directed at improving HAART initiation for eligible
pregnant women in the province of Kwa-Zulu Natal, South Africa
2012 SOMSA CONGRESS,ST GEORGES, TSHWANE
04 DECEMBER 2012Mrs Otty Mhlongo
PMTCT Manager - KZN
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Background
• KZN Province is at the epicenter of the HIV pandemic, (highest antenatal HIV prevalence- 39.5 %(DOH, 2010) in SA).
• Problem statement: 43.7 % of maternal deaths in SA, is due to non pregnancy - related infections, primarily HIV/ AIDS. (Saving Mother's Report 2005 -2007).
• HIV positive women eligible for HAART are not initiated timeously, leading to high MTCT rates, and maternal deaths.
• In March 2010, 52% of pregnant women eligible for HAART (CD4<350 and WHO stages 3 and 4) accessed treatment.
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• Simple method to identify gaps in the healthcare system
• Systematic way to close those gaps and safely improving the process of care
• Principles (WILL, IDEAS, EXECUTION):• Apply local wisdom • Focus on the data (stop the blame game)• Work “smarter” NOT just “harder”• Partnership and teamwork is the only way forward
“Quality Improvement” in healthcare
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RegulationStandardsProfessional oversightAccreditationPerformance review
QA
QA and QI
Evidence
Guidelines, protocols,
SOPs
Training Competencie
s
CQIAims: what are the “gaps”Measures: tools to measure the critical processes and outcomesChanges: frontline methods and activities to close the “gap”
IMPROVED OUTCOMES
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AIM • To increase initiation of all (100%) of pregnant
women who were eligible for ART onto treatment.
• Target population: All PMTCT/MCWH coordinators in the 11 Districts of KZN including operational health workers in all the public health facilities.
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Intervention
• A Continuous Quality Improvement methodology, aimed at health systems strengthening, improving the reliable delivery of processes.
• A 'dashboard 'of key indicators was tracked. The 20,000+ partnership (made up of the KZNDOH, IHI and UKZN) used tools to identify root causes of process failure, iterative tests of change (Plan-do-study-act cycles), and local data to guide improvement.
• “Wedge” meetings – meetings between hospitals and feeder clinics, focusing on indicator performance
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WHAT IS A DASHBOARD?
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DASHBOARDS
• Helps view the whole and guide the improvement team to whether changes are leading to improvements.
• Always in front of your eyes- helps team to focus
• A useful dashboard will have outcome, process and balancing measures
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Results
• HAART initiation increased to>80% (Q1 12/13 -85,3%)
• Data -focused approach to improvement using
• Noticeable decline in Maternal mortality from 392 in 2010 to 353 in 2011, and quarterly trend of Q1 2011/12 - 117 to Q1 2012/13 - 87.
• Reduced MTCT Q1 2012/2013 = 2.6%• MTCT – Collaborated with NHLS/MRC
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Results (Cont…)• Strong ties/collaboration with feeder clinics
and mother hospital(Wedge approach)• Team approach into solving problems• Common shared aim- working towards
achieving same goal • Perinatal review meetings – CQI standing item
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Jan-1
0
Mar-1
0
May-1
0Ju
l-10
Sep-10
Nov-10
Jan-1
1
Mar-11
May-1
1Ju
l-11
Sep-11
Nov-1
1
Jan-1
2
Mar-1
2
May-1
2Ju
l-12
Sep-12
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
110%
KZN ProvinceANC client Initiated on HAART
Months plus years
Perc
enta
ge=
AN
C c
lient
initi
ated
on
HA
AR
Tov
er A
NC
clie
nt e
ligib
le fo
r HA
AR
T
QI Project started
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KZN ProvinceANC client Initiated on HAART
(Raw numbers)
Jan-1
0
Feb-10
Mar-10
Apr-10
May-10
Jun-1
0Ju
l-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-1
1
Feb-11
Mar-11
Apr-11
May-11
Jun-1
1Ju
l-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-1
2
Feb-12
Mar-12
Apr-12
May-12
Jun-1
2Ju
l-12
0
500
1,000
1,500
2,000
2,500
3,000
Antenatal client initiated on HAART Antenatal client eligible for HAART
Raw
Num
bers
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KZN Baby PCR Positivity around six weeks
Jan-10
Mar-10
May-10
Jul-10
Sep-10
Nov-10
Jan-11
Mar-11
May-11
Jul-11
Sep-11
Nov-11
Jan-12
Mar-12
May-12
Jul-12
Sep-12
0%
2%
4%
6%
8%
10%
12%
14%
Time in months/years
Perc
enta
ge=
Baby
PCR
test
pos
. aro
und
6 w
eeks
over
Bab
y PC
R te
st a
roun
d 6
wee
ks
Changes Initiated
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Maternal mortality 2010/2011
2010 2011330
340
350
360
370
380
390
400392
353
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Maternal mortality
QRT 1 2011/2012 QRT 1 2012/20130
20
40
60
80
100
120
140
117
87
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Implications of a QI approach on the health system
• Quality Improvement approach is a leveraged strategy to improve health system performance towards better health outcomes.
• A multi-faceted/ multi-disciplinary approach that effectively improves the working and coordination of the health system through engaging:
- Leaders- Districts Programs / Data management team- Frontline workforce to be part of the solution- Data usage to guide improvement- Improved communication between hospitals and feeder clinics • End-product: Better use of existing resources and closing feedback
loop.
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Recommendations and future actions
• A data focused quality improvement approach, mentorship/support by Provincial, District and support of Partners at all levels including systematic approach to improvement can facilitate rapid achievement of national PMTCT/MCWH targets, thus meeting the Millennium Development Goals
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Conclusion
• Quality improvement approaches have helped to close the service delivery gaps for PMTCT interventions in KZN.
• The same replicable approaches can be applied to other areas of MCH care and other programs to help strengthen health systems.
• Applying same principles in working towards E-MTCT by 2015- Action Framework and achieving MDG 4, 5 and 6.
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Acknowledgements
KZN DOHMs Pinky Phungula –MCWH
Province UKZN- 20 000+ Partnership
Team- PEPFAR CDC fundedAll Partners
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