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SERVICE DELIVERY AS AN ENTRY POINT TO HEALTH SYSTEM STRENGTHENING

SERVICE DELIVERY AS AN ENTRY POINT TO HEALTH SYSTEM STRENGTHENING. A Case Study from Senegal: Improving the Tuberculosis System of Care Dr. Bruno Bouchet, Director Health Systems Assessment & Development. Three Key Messages.

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SERVICE DELIVERY AS AN ENTRY POINT TO HEALTH SYSTEM STRENGTHENING

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  1. SERVICE DELIVERY AS AN ENTRY POINT TO HEALTH SYSTEM STRENGTHENING A Case Study from Senegal: Improving the Tuberculosis System of Care Dr. Bruno Bouchet, Director Health Systems Assessment & Development

  2. Three Key Messages • Formal Quality Improvement (QI) efforts improve the performance of public health programs (disease-specific health outcome) • QI addresses systems’ issues that affect service delivery, with potential spillover to other services/health conditions • QI should be a key component of a Health Systems Strengthening (HSS) strategy

  3. What Did We Want to Accomplish? • Goal: Improve the health systems for patients with TB in Mbao District, Senegal: • Lost-to-follow-up: 23% to 7% (national target < 5%) • Cure rate: 55% to 77% in 5 years (target ≥ 85%) • We used the Collaborative Model for Improvement: • Improvement objectives, systems analysis & QI teams • Monthly monitoring of process/output/outcome measures on run charts • Coaching of QI teams/health providers • Testing changes through PDSA (Plan-Do-Study-Act) • Learning sessions to share results and ideas • Scaling-up improvements

  4. Improvement Matrix

  5. Did the Quality of TB Care Processes Improve? Regular Intake under TDO HIV testing Changes Changes TB Tx Started Same Day Bacteriological Exams M2, M5, M6 Changes Changes

  6. Did the Performance of the TB System of Care Improve? % of TB Patients Lost-to-Follow-Up 30 QI Stopped Changes Arrêt de la collecte des données Introduction de Changements 25 20 Percentage LTFU 15 10 5 Cure Rate 0,00 August-09 March-08 March-10 Months First Cohort of “QI” patients QI Stopped Changes 100 90 National Objective 85% 80 70 60 50 40 Sept-08 Mar-09 Mar-10 Aug-09

  7. Is the Senegal Health System “Stronger”? Depends on the interactions between a public health goal (or program) and the health system. 3 options: • Yes, The HS is stronger because the TB system of care is stronger… …provided TB improvement does not come at expense of another service • Maybe improved TB services also benefit other services …provided we have the data to demonstrate the spillover (by design or by chance?) • No, improved TB services had no effect on “cross-cutting” national functions (5 other building blocks)

  8. Added Value of QI for Health Programs and Health Systems National Target: 80% QI zone Public Health Program 8

  9. Key Issues for Debate • Why is not “modern” QI a systematic component of every public health program or HSS strategy? • How should a disease-control program be designed to also strengthen the health system?

  10. Thank you!

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