16
1 Integrating M&E at the clinic level Amy F. Stern USAID HEALTH CARE IMPROVEMENT PROJECT (HCI) UNIVERSITY RESEARCH CO., LLC February 22, 2012
| Date post: | 18-Dec-2014 |
| Category: |
Health & Medicine |
| Upload: | nacsconf |
| View: | 247 times |
| Download: | 2 times |
1
Integrating M&E at the clinic level
Amy F. SternUSAID HEALTH CARE IMPROVEMENT PROJECT (HCI)
UNIVERSITY RESEARCH CO., LLCFebruary 22, 2012
USAID HEALTH CARE IMPROVEMENT PROJECT
Facility Identify &
address gaps in care
Region/DistrictSupport, coach & mentor
NationalInform
National planning
Data use at each level of health system.
ShowImpact ofPrograms
Global
USAID HEALTH CARE IMPROVEMENT PROJECT
Effective M&E integration at the clinic level: key lessons
1. Use metrics relevant to the clinic– Denominators reflective of clinic patients
2. Make data collection part of the daily routine– Document in clinic data collection tools.
3. Use data to inform decisions to improve clinic performance– Monthly review and analysis; identify gaps in service
delivery, test changes to improve performance and close the gap
4
1. Use metrics relevant to the clinic
USAID HEALTH CARE IMPROVEMENT PROJECT
Use clinic based denominator
Output Indicator 1
The # and proportion of undernourished PLHIV that received therapeutic or supplementary food at any point during the reporting period
Numerator: # of clinically undernourished PLHIV that received therapeutic or supplementary food
Denominator: # of PLHIV nutritionally assesses & found to be clinically undernourished (who visited this facility)
USAID HEALTH CARE IMPROVEMENT PROJECT
Feasible quality criteria by region
East Africa *
Eurasia ++
West Africa *
Southeast Asia +
Southern Africa *
0
10
20
30
40
50
60
70
80
90
100
National LevelFacility Level
Feasible Quality Criteria
Per
cent
USAID HEALTH CARE IMPROVEMENT PROJECT
The value of process indicators
Process measures are more sensitive and more useful performance indicators
than outcome measures when looking at a narrower perspective such as a
clinic, department, hospital.1
1Mant J. 2001. Process versus outcome indicators in the assessment of quality of healthcare. Accessed on:23 Jan. 2012. Available at: http://intqhc.oxfordjournals.org/contents/13/6/475.full.pdf+html
8
2. Make data collection part of the daily routine
9
3. Use data to make decisions to improve clinic performance
USAID HEALTH CARE IMPROVEMENT PROJECT
w-20
w-17
w-14
w-11
w-8 w-5 w-2 w2 w5 w8w11 w14 w17 w20 w23 w26
0102030405060708090
100
%
Nutrition training
Delivery of commodities
% of clients whose nutritional status is assessed using mid-upper arm circumference (MUAC)
USAID HEALTH CARE IMPROVEMENT PROJECT
w-20
w-17
w-14
w-11
w-8 w-5 w-2 w2 w5 w8w11 w14 w17 w20 w23 w26
0102030405060708090
100
%
Nutrition training
Delivery of commodities
% of clients whose nutritional status is assessed using mid-upper arm circumference (MUAC)
Tell everyone to do MUAC a non-sustained change
Assign a staff person to do MUAC after registrationA sustained change
Train expert clients to do MUAC
USAID HEALTH CARE IMPROVEMENT PROJECT
Develop changes to test
• Where is the best place to assess?• Who should assess?• How can the findings be recorded?• How to link clients with treatment?
USAID HEALTH CARE IMPROVEMENT PROJECT
Key results, Kenya: Change ideas tested to improve nutritional assessment of HIV patients
1. Relocated place for nutritional assessment from clinician room to registration desk
2. Re-assigned task of assessing nutritional status to expert patients
3. Synchronized RUTF collection date with ARV follow-up dates
4. Began collecting details of clients (home address, cell phone number, etc.) to help trace those who miss follow-up appointments
5. Revised patient flow to enable easier movement of clients from one service area to another and to decrease waiting time
6. Testing changes in other parts of facilities e.g. now at MNCH
7. Successful lobbying for anthropometric equipment from partner organizations to enable nutritional assessments at the facility
USAID HEALTH CARE IMPROVEMENT PROJECT
BASELINE
SEP WK1
SEP WK2
SEP WK3
SEP WK4
OCT WK1
OCTWK2
OCT WK3
OCT WK4
NOV WK1
NOV-WK2
NOV WK3
NOV WK 4
# of HIV +VE clients assessed for Nutritional Status and categorize MAM SAM,Normal,Obese
0 49 148 109 138 214 253 162 211 202 244 270 220
Total # of HIV positive clients visiting the health facility
0 57 169 224 161 217 254 165 212 202 247 275 257
Clients Nutritionally assesed and categorized
0 85.96 87.57 93.3 85.71 98.6 99.6 98.2 99.5 100 98.7 98.1 85.6
10
30
50
70
90
Percentage of HIV Patients Assessed for Nutritional Status from Ambira Hospital in KenyaSeptember through November 2011
Pe
rce
nta
ge
Numerator: # of HIV infected clients assessed for nutritional status and categorized :Denominator# Total of HIV infected patients visiting the health facility that month Data Source/SamplingHIV Register :
Key results, Kenya: Increasing nutritionalassessments for HIV infected patients
USAID HEALTH CARE IMPROVEMENT PROJECT
Best practices
• Integrate assessment with existing registration or triage stations
• Have expert clients help with the additional work load– Train enough expert clients to accommodate for when
some are not available– Provide supervision/mentorship for expert clients
• Document nutrition status in existing registry rather than creating a new document
USAID HEALTH CARE IMPROVEMENT PROJECT
Effective M&E integration at the clinic level: key lessons
1. Use metrics relevant to the clinic– Denominators reflective of clinic patients
2. Make data collection part of the daily routine– Document in clinic data collection tools.
3. Use data to inform decisions to improve clinic performance– Monthly review and analysis; identify gaps in service
delivery, test changes to improve performance and close the gap
