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 2012 Mrs Otty Mhlongo PMTCT Manager - KZN
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2012 SOMSA CONGRESS, ST GEORGES, TSHWANE 04 DECEMBER 2012 Mrs Otty Mhlongo PMTCT Manager - KZN
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 Presentation
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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
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.
• 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
CQIAims: what are the “gaps”Measures: tools to measure the critical processes and outcomesChanges: frontline methods and activities to close the “gap”
IMPROVED OUTCOMES
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.
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
WHAT IS A DASHBOARD?
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
Antenatal client initiated on HAART Antenatal client eligible for HAART
Raw
Num
bers
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
Maternal mortality 2010/2011
2010 2011330
340
350
360
370
380
390
400392
353
Maternal mortality
QRT 1 2011/2012 QRT 1 2012/20130
20
40
60
80
100
120
140
117
87
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.
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
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.