Transcript Slide 1
Quality Management Information System (QMIS) Enhances Local Level Management Capacity for Quality Management: Lessons from Rural Bangladesh Mohammad Alauddin, PhD Salah Uddin Ahmed, MBBS 130th Annual APHA Convention-Philadelphia November, 2002 Background RSDP Covers Number of Thanas (Subdistrict): 139 out of 464 Thanas Population Covered about: 9 million Eligible couples: 2 million Children less than 1(<1): 200, 000 Children less than 5(<5): 1.2 million Service Delivery Structure Pathfinder-RSDP works through a three-tier service delivery structure consisting of static clinic, satellite clinics, and Depot Holders in specified catchment areas of 139 thanas. Service Delivery Structure Levels Service Delivery Points STATIC CLINIC Union Ward 139 Clinics/Daily SATELLITE CLINIC 5,675/month Providers Physicians (6) Paramedics/FWVs (450) Clinic Aide (457) Paramedic/FWV (450) Clinic Aide (457) Community Mobilizer (455) Depotholder (6,035) Village DEPOTHOLDER 16,800 Daily visits Depotholder(6,035) RSDP Service Delivery Points Static Clinic: Open six days a week to provide full range of ESP services, generally it is hired by the NGOs Satellite Clinic: Held once in a month in the community, they arrange space for the satellite clinic. Provide minimum ESP services Depot Holder: The Depot Holders are selected from the community, available all the time in the community to provide selected ESP services. They provide information about the services and service delivery points (Static & satellite) to the community and also provide selected ESP services Experience from RSDP that provide ESP RSDP (Rural Service delivery Partnership) mainly deliver following ESP(Essential Services Package) Reproductive health Family Planning Maternal Health RTI/STD/HIV/AIDS Child health Limited curative care (LCC) Communicable Disease Control Behavioral Change Communication (BCC) Pathfinder conducted two types of Quality Improvement Activities: Direct & Indirect Quality Assurance visits to NGO clinics COPE exercise with NGO staff Training to non-medical supervisors Direct Training to NGO physicians and paramedics on Rational Drug Use Development of Manuals and Standards Development of Job Aids and training paramedics on how to use them Worked in collaboration with PRIME in: • Selection, preparation and monitoring of appropriate training institute Indirect • Development of Training Curriculum • Training Paramedics, Physicians, Community mobilizer and Depot holders on peer coaching • Follow up of training impact Pathfinder Quality Assurance Process: Sequence to build Quality capability QA-1 Emphasized on: Setting up physical facilities Joint visit by RSDP & QIP QA staff Single checklist used NGO HQ Representative as trainee observer only QA- 2 Focused on: Service delivery processes Two steps process followed to transfer skills: QA-3 Focused on Compliance to service delivery standard Step -1: NGO participation began - NGO assessed physical facilities by using a checklist Transferred skill to the NGOs to conduct QA visits: Step -2: QA team observed NGO service providers at work by using a checklist NGO staff along with RSDP conducted QA visit (64 clinics) Two checklist used QA team - QIP-RSDP jointly visited 75 clinics Composite Indicators used in Quality Assurance (QA) Visits Clinic facilities Maternal health Counseling Infection Prevention Family Planning/ Reproductive Tract Infection (FP/RTI) Rational Drug Use (RDU) Child health Referral QA data comparison among rounds 87 1 00 56 80 QA-1 QA-2 QA-3 60 38 40 20 0 1 st r ound 44 51 60 49 87 51 11 8 56 38 M ea n 32 50 3r d r ound 79 RD U 49 67 56 91 al el lin g 33 45 92 91 M at er na lh ea lth Ch ild In he fe al ct th io n Pr ev en tio n 61 83 Re fe rr 84 81 Co un s Cl in ic 99 FP /S TD 97 fa ci lity 120 100 80 60 40 20 0 2nd r ound The average Quality Composite score of 139 Clinics in round-3 is 87 percent; first and second round average scores were 38 & 56 percent, respectively. Plan for QA visit Conduct QA visit at the clinic CAP follow up by the NGO & RSDP after 3 month Implement CAP Develop Compliance Action Plan (CAP) Develop Scoring using Checklist indicators Quality Management Information System (QMIS) Compare with Previous score Analyze Causes Identify indicators lagging behind in Quality Lessons Learnt in Rural Bangladesh……….. Common understanding of QA initiatives across the system is necessary Quality improvement needs to be responsive to situations and need based Quality can be improved even in rural settings and situations Perception of quality and mindset of reviewers and providers need to be on the same understanding QA initiatives has led to strengthening of partnerships QI is not one shot initiative, it’s a continuous process, builds on phases and in sequence Conclusions During the four and half years it is found that Quality can be improved even in rural settings and situations. Pathfinder- RSDP conducted three round Quality Assurance visits and found improvements in all the composite indicators. The average QA composite indicators during the first and second round were 38 & 56 percent respectively whereas the third round average QA composite scores was 87 percent.