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Kenya Nutrition Quality Improvement Demonstration

ProjectRarieda, Bondo, Siaya & Ugenya Districts

Ram Shrestha, Senior Quality Improvement AdvisorUSAID Health Care Improvement Project

University Research Co., LLC

February 22, 2012

USAID HEALTH CARE IMPROVEMENT PROJECT

FBP sites in Nyanza Province

District

Site statusTotal

Primary SatelliteBondo 1 8 9Gucha 1 0 1

1 4 5Kisii 2 5 7Kisii Central 1 0 1Kisumu 6 14 20Kuria West 1 0 1Migori 3 29 32Muhoroni 1 0 1Nyando 3 11 14Rachuonyo 2 6 8Rongo 0 1 1Siaya 2 25 27Suba 1 15 16Yala 1 5 6

Total 28 121 149

USAID HEALTH CARE IMPROVEMENT PROJECT

1. Overstay in the program

2. High drop out rates

3. Food storage considerations

4. Sharing of food

5. Nutrition assessment

6. Need to address malnutrition

7. Nutrition counseling and education

8. Data capture and reporting

9. Supply Chain disruptions/breakdowns

Nutrition-HIV Gaps/Challenges

Sources: AIDSTAR Report 2010,Kemri OR- 2010,FANTA review 2007

USAID HEALTH CARE IMPROVEMENT PROJECT

Demonstration quality improvement project

Objective:

To improve the Quality of Nutrition services at health facilities for PLHIV in Nyanza province

USAID HEALTH CARE IMPROVEMENT PROJECT

Nutrition/HIV QI sites

Siaya District1. Siaya District Hospital 2. Yala Sub-District HospitalUgenya District4. Ambira Sub-District Hospital5. Ukwala Health CenterBondo District7. Bondo District Hospital8. Got Agulu Sub-District HospitalRarieda District10. Madiany District Hospital11. Ongielo Health Center

USAID HEALTH CARE IMPROVEMENT PROJECT

QI Approach

USAID HEALTH CARE IMPROVEMENT PROJECT

The QI process begins by:

• Identifying problems

• Analyzing Problems

• Developing Change Ideas

• Testing Change Ideas

• Measuring Improvements

USAID HEALTH CARE IMPROVEMENT PROJECT

Focus on “SYSTEMS’ THINKING”

USAID HEALTH CARE IMPROVEMENT PROJECT

Model of a system

Resources necessary to carry out a process

Inputs

The sum of all elements (including processes) that interact together to produce a common goal

Quality Improvement

USAID HEALTH CARE IMPROVEMENT PROJECT

Model for Improvement

USAID HEALTH CARE IMPROVEMENT PROJECT

Example: QI activities in Bondo

District Hospital

USAID HEALTH CARE IMPROVEMENT PROJECT

Elements of QI :

•QI Teams

•Coaches

•Regular QI Team Meetings

•Testing Improvements (PDSA Cycle)

•Participate in Learning Sessions

Quality improvement approach

USAID HEALTH CARE IMPROVEMENT PROJECT

Bondo DH QI members

• Coach, Nutrition Officer

• Social worker

• Clinical officer (PMTCT)

• Nurses

• Data

• Counselor

• Pharmacist

• FBP assistant

• Mentor Mother

• Clinical officer (ART)

USAID HEALTH CARE IMPROVEMENT PROJECT

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

BLCoaching

12th month

QI implementation activities: Timeline

CoachingCoaching Coaching

ELLSLSLS

1st month

3rd month 6th month 9th month

USAID HEALTH CARE IMPROVEMENT PROJECT

Service delivery: 7 steps

15

USAID HEALTH CARE IMPROVEMENT PROJECT

Improvement objective: Nutritional assessment and categorization of all clients at every visit

• Indicator for the objective: No. of clients assessed and categorized

• Numerator: Clients assessed

• Denominator: Clients visiting the PSC /CCC

• Data source (Numerator) – BMI/Z-score book

• Data source (Denominator)- Appointment diary

USAID HEALTH CARE IMPROVEMENT PROJECT

Laboratory

Reception

Counselling

Pharmacy

CommunityClinician (hit,wt, MUAC)

FBP

PLHIV flow mapping before QI intervention

USAID HEALTH CARE IMPROVEMENT PROJECT

Process map

1. Why do you need improvement? 2. What are we trying to accomplish?

3. What changes will lead to an improvement?

Process map

Fishbone diagram

Tools

Inputs

Present Performance

Desired Performance

Processes Outcome

4. How do we know if there is improvement?

USAID HEALTH CARE IMPROVEMENT PROJECT

Reception(ht, wt, MUAC)

Triage Community

Clinician

Pharmacy

FBP

LaboratoryCounseling

PLHIV patients flow after QI intervention

Intervention results