training in case management: lessons learnt working in the lake … · 2019-12-17 · training in...
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Training in case management: Lessons learnt working in the Lake
Zone, Tanzania, 2012 - 2014
Tibu Homa Dissemination Workshop,
13th – 14th November, 2014
Dr. Festus M. Kalokola
Presentation Outline
• Introduction
• Methodology
• Results
• Lessons learnt
IMCI Implementation
• Integrated Management of Childhood Illnesses (IMCI) was introduced in Tanzania in 1996 and scaled up in all districts in 1998.
• Referral Care Manual (RCM) adopted as a policy in 2005 to address 10-20% of under fives (UFs) referred.
• IMCI implementation improved quality of care provided by health care workers (HCWs), lowered UF mortality by 13%, and was cost effective (Bryce MCE, 2005).
• Councils were unable to sustain the 11 day training.
Factors contributing to HCWs non-adherence to IMCI guidelines
• Use of single diagnoses rather than IMCI classifications
• Shortage of medicines and supplies
• Frequent turnover among trained HCWs
• Inadequate mentorship and supportive supervision
• Inadequate supplies of IMCI guidelines and job aids
• Insufficient refresher courses
Training methods used by THP
• 5-6 HCWs of hospital pediatric quality improvement teams (PQITs) undergo 6-day training (3 days in quality improvement (QI) and 3 days RCM/ supply chain management (SCM).
• 5-6 PQIT HCWs from health centers (H/Cs) and 1-2 PQIT members from dispensaries receive 6-day training ( 3day in QI and 3 days IMCI/SCM training package training for all.
• Training for H/Cs and dispensary later changed to a 10 weeks course using dIMCI (3 one day face to face encounter with facilitators) QI and SCM is integrated at first encounter (6 days)
• Analyze gaps in case management (CM) and develop QI improvement plans.
Training methods used by THP (cont’d)
• Reorient IMCI facilitators on updated guidelines to serve as clinical mentors.
• Regional and Council Health Management Teams (R/CHMTs) and clinical mentors undergo a 6-day comprehensive supportive supervision and mentorship (CSSM) training.
• Provide monthly clinical, logistic supplies and QI mentorship, and data management support.
• Provide feedback to PQIT/health management team (HMT) and the rest of R/CHMT.
Region and district coverage to date
Region Facility level Community levelDistrict District Ward
Kagera Misenyi Misenyi Kilimilile, Kasambya
Muleba Muleba Kasharunga, Gwanseri
Karagwe, Ngara, Biharamuro, Bukoba Urban, Bukoba Rural and Kyerwa
Mwanza Sengerema Sengerema Mwalubuhi, Katwe Nyamagana Nyamagana Igoma, MkolaniMagu, Misungwi, Kwimba, Ukerewe, and Ilemela
Mara Musoma Rural Musoma Rural Butiama, Bisumwa Tarime Tarime Muriba, Susuni Rorya, Serengeti, Bunda,and Musoma Urban
Geita Geita MC Geita Kalangarare, Katoro
Geita DC, Mbogwe, Chato, Bukombe and Nyanwale
Shinyanga Shinyanga MCKishapu Kishapu Kishapu, Binambiyu
Simiyu Maswa DC Maswa Buchambi, Shishiyu
Maswa DCBariadi TC and Bariadi DC
Training accomplishments through March 2014, by facility, community, cadre
Facility/Cadre
Period
% of health facilities coveredOct 12 - Sept 13 Oct 12 - Mar 14
Hospitals 41 47 87.2%
Health Center 49 68 50%
Dispensary 107 286 25%
Total H/Facilities 197 396 29.8%
HCWs 1085 1279
Clinical Mentorship 148 176
CHW 166 166
Medicine Therapeutic committees
50 70
Tibu Homa training activities
Tibu Homa Project Health Facility (PQIT)
Between 2011 and March 2014: trained 1279 HCWs in updated case management guidelines, using an approach that combines QI methods and standardized case management; formed 396 health facility PQITs in three regions.
Redesigned case management flow maps that resulted in improving clinic efficiency
Between 2011 and March 2014: trained and mentored 267 QI coaches, logistic and 176 clinical mentors among the R/CHMTs.
Improved compliance to case management guidelines (IMCI and RCM)
Conducted monthly coaching and mentorship in collaboration with R/CHMT
Improved diagnosis of malaria and other causes of fever
Conducted 3 learning sessions Improved health facility stocks of essential medicines and supplies
Conducted 2 harvest and synthesis workshops
Improved health information system and using data for decision making
In the year 2013, prepared a change package
Lessons learnt
• Improving HCWs’ performance is achieved through classroom and on-the-job training.
• Selection of participants should be done through RMOs, DMOs and MO in-charges.
• Participants should be informed that they will be expected to train other HCWs after receiving training.
• Include on-job-training in the health facility routine activities through case reviews/presentations and death audits.
Lessons learnt (cont’d)
Compliance to standard guidelines depends on:
• Performance of health care workers
• Coverage of IMCI within the Health Management Information System (HMIS)
• Availability of IMCI guidelines and job aids
• Adequate human resources
• Availability of IMCI content in routine supervision
• Availability of medicines and supplies
Lessons learnt (cont’d)
• PQITs have been found to address these problems by applying QI methods, testing and implementing practices that have been proven to bring results.
• Functional PQIT teams are those receiving support from HFM (work plans included into the health facility (HF) and comprehensive council health plans (CCHP)
• Faster improved case management is associated with internal/external on-the-job training and regular comprehensive supportive supervision/mentorship.
Lessons learnt (cont’d)
THP has also observed that using a collaborative improvement method where health facility teams come together to present and share improvement results have been associated with shared learning and scaling up best practices and overall rapid improvement.
Improvement collaborative model
Mobilise
National
Leadership/
stakeholders
Form
Technical
Leader Group
and
Collaborative
Management
Structure
Select
Region
s and
Sites
Finalise
Technical
Content/
Change
Package
Thank you.
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