Guyana Ministry of Health

HEALTHQUAL GUYANA PROJECT Integrating Quality Management into National Health Infrastructure Presenter

Mr. Nicholas Persaud National HIV Care and Treatment Coordinator

HEALTHQUAL Guyana    

Background information & Genesis Benefits to Guyana Challenges Lesson Learnt

HEALTHQUAL Guyana Guyana’s 2008-12 NHSS identified 4 goals guiding health sector development

 Equity in distribution of health knowledge, opportunities and services  Consumer-oriented services: people focused and user friendly  High quality services (and good value for money)  Accountable providers and government  Quality of care is therefore an integral part of the sector strategy!  Ensure universal access to quality diagnostic care treatment and support for all persons infected by HIV/AIDS including access to ARVs and quality home based care services (Guyana HIV/AIDS Strategy 2007-11)

HEALTHQUAL Guyana  Began as a collaboration between Guyana’s MOH, UNICEF, HIVQUAL Int’l and CDC Guyana  Initial intent was HIVQUAL i.e HIV quality of care (adults and children)  But………MOH was particularly interested in applying HIVQUAL to deliver on sector wide improvement of quality of care  Including establishing a MOH’s quality management programme  Quality of HIV care was initial test of health sector improvement of care  Hence Guyana HEALTHQUAL Project was born - HIV & Well Child Care

Implementation  HEALTHQUAL steering committee was established  Co-chaired by NAPS and MCH  Membership from supporting agencies such as UNICEF, CDC, FXB/UMDNJ and AIDS Relief

 Implementation coordinated initially by NAPS  Subsequently jointly after a MCH HEALTHQUAL field officer was recruited

 Indicators of HIV & WELL CHILD care were jointly developed  well child indicators- selection based on MCH guidelines

 Selection of clinic sites (3 types)  HIV  Well Child  Well Child and HIV -20 Pilot Sites

( Explore the level of care provided with the varying service entity ) .

Advantages  Several sites (6)with both ART and Well Child care provided (Integration)  In some cases by the same personnel ( Able to address quality of care holistically)

 Well Child medical record are easily available and accessible.  QI methodology was standardized, simple and easily diffusible.  Many (6)well child sites provides PMTCT services  Lends to programme integration

 Utilization of MCH regional supervisors to support and guide implementation regionally  Facilitates coaching, mentoring and support for clinical sites,  able to integrate QI model at different facilities where project was not piloted.

Challenges  Coordination: difficult for single coordinator to work with both HIV and Well Child sites  Patient information was not always available in both patients records. ( Well Child & HIV)  Insufficient time for central coordinators to coach regional sites ( Geographic demography)  Inadequate human resources at site to effectively address quality of care issue.( e.g Two staff with a patient load of 55 daily)  Promoting a culture of quality. (Ownership)  High staff attrition

Lessons Learnt  Important to recruit MCH HEALTHQUAL Officer to aid in coordination  Essential for MCH regional supervisors be trained & equipped to support regional sites (For decentralization)  During data entry separate clinics, if there are integrated ( simplify analysis)  Imperative for regular meeting /training to help promote peer learning through sharing of experiences and quality improvement ideas.  Assess inventory of site to identified needs and gaps  Use of extraction sheet important (helps verification, allow multiple persons to extract information i.e reduce time significantly)  Need to have regional integration and participation to support sustainability and promote leadership.  Quarterly feedback on progress most appropriate reporting methodology. ( Adequate to measure progress)

Lessons Learnt  Cause and Effect ( fish bone ) Diagram couple with brain storming is an effective method for exploring quality of care.  A valuable medium for promoting culture of quality care  An excellent tool for assessing sites performance and facilitate comparison among sites ( Identify best practices and gaps)

Way Forward  Expanding to additional fifteen (15) MCH clinics and one (1) reaming ART Site in second audit.  Advocate support and leadership from regional authority  Continued guidance and leadership from the Ministry of Health in overall program implementation.