Standards-Based Management and Recognition (SBM-R)

Measuring Quality and Evaluation Results from Zambia "

By Young Mi Kim ! Presented at ICN, Australia, May 2013 "
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Contents !
1. How do we measure quality improvement? ! 2. What are the ndings from the evaluation of a Zambia SBM-R intervention?!

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Measuring Quality Improvement "

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Assessing Quality from Different Perspectives "

Providers (self- or peer assessment)! Experts ! Clients! Others (e.g., managers, lab technicians)!
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Data Collection Methods (1) "

Provider self-assessments! Observation of actual consultations! Observation of simulations with anatomical model or mannequin! Inventory of supplies and equipment!

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Data Collection Methods (2)"

Provider interviews! Client exit interviews! Review of patients chart! Analysis of service data!

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Assessment Tools"
Original SBM-R assessment tools! Simplied version of the SBM-R assessment tools! Interview guides (structured or unstructured)! Inventory checklist ! Forms to abstract clients chart or service data!
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Background"
The Zambia Defence Force operates a network of 54 facilities that serve civilians as well as military personnel! Services to prevent mother-to-child transmission of HIV (PMTCT) were incorporated into antenatal care ! Jhpiego assisted Zambia Defence Force to implement SBMR over the past six (6) years!
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Purpose of Evaluation "

To assess the impact of a quality improvement program on: ! PMTCT services quality ! Support systems!
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Zambia SBM-R Interventions"

Onsite SBM-R training (3 days)! Onsite PMTCT training for health workers (6 days); also 6 days for PMTCT lay workers! Task shifting to PMTCT lay workers! Supportive supervision and mentorship! Provision of some equipment and supplies!
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Study Design"
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A quasi-experimental study design! Baseline and end-line data collection ! In 4 intervention and 4 control facilities! Total of 387 ANC consultations were observed !
First round of data collection" (May/June 2010) X X"
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SBM-R intervention"

Second round of data collection" (Nov/Mar 12)" X" X"

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Intervention group comparison group

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Overall ANC and PMTCT Scores: Percentage of tasks completed - Zambia "

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HIV Counseling and Testing: Percentage of tasks completed - Zambia "

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HIV/AIDS Management in Pregnancy: Percentage of tasks completed - Zambia "

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Discussions"
Providers were not consistently following PMTCT guidelines that call for: !
Repeating HIV tests for pregnant women every three months if the initial test is negative! Reinforcing HIV counseling during every ANC visit!

Quality improved far more at intervention than comparison sites, suggesting that the SBM-R intervention had a positive impact on PMTCT services!

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 Evidence of quality improvement due to SBM-R intervention in military settings! Improved problem-solving capacity by facility! Facility readiness improved in both intervention and comparison (JSIs efforts for logistics)!

Conclusions"

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Acknowledgment!
(Jhpiego/Zambia) Maureen Chilila, Hildah Shasulwe, Joseph Banda, Webby Kanjipite! (Jhpiego/USA) Supriya Sarkar, Eva Bazant, Cyndi Hiner, Maya Tholandi, Stephanie Reinhardt, Adrienne Kols! (ZDF) Joyce Chongo Mulilo!
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Acknowledgment!
The U.S Presidents Emergency Plan for AIDS Relief through the Department of Defense (DOD) provided funding for this evaluation.!

Thank You! "

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