1. Kenya Nutrition Quality
Improvement Demonstration
Project
Rarieda, Bondo, Siaya & Ugenya Districts
Ram Shrestha, Senior Quality Improvement Advisor
USAID Health Care Improvement Project
University Research Co., LLC
February 22, 2012
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2. FBP sites in Nyanza Province
Site status
District Total
Primary Satellite
Bondo 1 8 9
Gucha 1 0 1
1 4 5
Kisii 2 5 7
Kisii Central 1 0 1
Kisumu 6 14 20
Kuria West 1 0 1
Migori 3 29 32
Muhoroni 1 0 1
Nyando 3 11 14
Rachuonyo 2 6 8
Rongo 0 1 1
Siaya 2 25 27
Suba 1 15 16
Yala 1 5 6
Total 28 121 149
USAID HEALTH CARE IMPROVEMENT PROJECT

3. Nutrition-HIV Gaps/Challenges
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
Sources: AIDSTAR Report 2010,Kemri OR- 2010,FANTA review 2007
USAID HEALTH CARE IMPROVEMENT PROJECT

4. 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

5. Nutrition/HIV QI sites
Siaya District
1. Siaya District Hospital
2. Yala Sub-District Hospital
Ugenya District
4. Ambira Sub-District Hospital
5. Ukwala Health Center
Bondo District
7. Bondo District Hospital
8. Got Agulu Sub-District Hospital
Rarieda District
10. Madiany District Hospital
11. Ongielo Health Center
USAID HEALTH CARE IMPROVEMENT PROJECT

6. QI Approach
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7. The QI process begins by:
• Identifying problems
• Analyzing Problems
• Developing Change Ideas
• Testing Change Ideas
• Measuring Improvements
USAID HEALTH CARE IMPROVEMENT PROJECT

8. Focus on “SYSTEMS’
THINKING”
USAID HEALTH CARE IMPROVEMENT PROJECT

9. Model of a system
The sum of all elements (including processes) that
interact together to produce a common goal
Quality Improvement
Inputs
Resources
necessary to
carry out a
process
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10. Model for Improvement
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11. Example:
QI activities in Bondo
District Hospital
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12. Quality improvement approach
Elements of QI :
•QI Teams
•Coaches
•Regular QI Team Meetings
•Testing Improvements (PDSA Cycle)
•Participate in Learning Sessions
USAID HEALTH CARE IMPROVEMENT PROJECT

13. Bondo DH QI members
• Coach, Nutrition Officer • Pharmacist
• Social worker • FBP assistant
• Clinical officer • Mentor Mother
(PMTCT) • Clinical officer (ART)
• Nurses
• Data
• Counselor
USAID HEALTH CARE IMPROVEMENT PROJECT

14. QI implementation activities: Timeline
BL LS LS LS EL
Coaching Coaching Coaching Coaching
QI QI QI QI QI QI QI QI QI QI QI QI
m m m m m m m m m m m m
1st month
3rd month 6th month 9th month 12th month
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15. Service delivery: 7 steps
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16. 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

17. PLHIV flow mapping before QI intervention
Reception
Counselling Clinician (hit,wt, Community
MUAC)
Laboratory Pharmacy
FBP
USAID HEALTH CARE IMPROVEMENT PROJECT

18. Process map
1. Why do you need improvement? 2. What are we trying to
accomplish?
3. What changes will lead to an
improvement? 4. How do we know
if there is
Process map improvement?
Fishbone diagram
Desired Performance
Tools
Inputs Processes Outcome
Present Performance
USAID HEALTH CARE IMPROVEMENT PROJECT

19. PLHIV patients flow after QI intervention
Reception
(ht, wt, MUAC)
Triage
Community
Clinician
Counseling Laboratory
Pharmacy
FBP
USAID HEALTH CARE IMPROVEMENT PROJECT

20. Intervention results