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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.
A continuous quality improvement(CQI) approach directed at improving HAART initiation for eligible pregnant women in the province of Kwa-Zulu Natal, South Africa2012 SOMSA CONGRESS,ST GEORGES, TSHWANE 04 DECEMBER 2012Mrs Otty MhlongoPMTCT Manager - KZNKZN 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. BackgroundSimple method to identify gaps in the healthcare systemSystematic way to close those gaps and safely improving the process of carePrinciples (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 healthcareRegulationStandardsProfessional oversightAccreditationPerformance reviewEvidenceQAGuidelines, protocols, SOPsTraining CompetenciesIMPROVED OUTCOMESAims: what are the “gaps”Measures: tools to measure the critical processes and outcomesChanges: frontline methods and activities to close the “gap”CQIQA and QITo 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. AIM 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 InterventionWHAT IS A DASHBOARD?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 measuresDASHBOARDSHAART 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 ResultsStrong ties/collaboration with feeder clinics and mother hospital(Wedge approach)Team approach into solving problemsCommon shared aim- working towards achieving same goal Perinatal review meetings – CQI standing itemResults (Cont…)QI Project startedKZN ProvinceANC client Initiated on HAART(Raw numbers)KZN Baby PCR Positivity around six weeksChanges InitiatedMaternal mortality 2010/2011 Maternal mortality 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 teamFrontline workforce to be part of the solutionData usage to guide improvementImproved communication between hospitals and feeder clinics End-product: Better use of existing resources and closing feedback loop.Implications of a QI approach on the health systemA 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 Recommendations and future actionsQuality 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. ConclusionAcknowledgements
  • Ms Pinky Phungula –MCWH Province
  • UKZN- 20 000+ PartnershipTeam- PEPFAR CDC funded
  • All Partners
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