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Mirwais Rahimzai MD, MBA, MPH (USA) April 07, 2011- Amsterdam

Leading Change From the Front Line In Afghanistan USAID Health Care Improvement (HCI) Project University Research Co., LLC Center for Human Services. Mirwais Rahimzai MD, MBA, MPH (USA) April 07, 2011- Amsterdam . Outline . Brief Country Profile What and Where

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Mirwais Rahimzai MD, MBA, MPH (USA) April 07, 2011- Amsterdam

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  1. Leading Change From the Front LineInAfghanistan USAID Health Care Improvement (HCI) ProjectUniversity Research Co., LLCCenter for Human Services Mirwais Rahimzai MD, MBA, MPH (USA) April 07, 2011- Amsterdam

  2. Outline • Brief Country Profile • What and Where • URC Activities at 4 Levels: • Hospital Level • Health Facility Level (BPHS) • Community Level • National level • Keeping Quality Improvement Understood and Active at Different Levels

  3. Brief Country Profile Population: About 25million Maternal Mortality: 1,600/100,000 LB Infant Mortality: 129/1,000 LB Under 5 mortality: 191/1,000 LB Fertility Rate: 6.3 CPR: 24% (Modern + Traditional) BPHS: Coverage about 85% of the country EPHS: Coverage about 60% of the country Hemorrhage, Obstructed Labor, Sepsis, PIH Asphyxia, Infection, LBW

  4. HCI Goal in Afghanistan 533,518 out of 1,144,800 people in Balkh 477,677 out of 882,900 people in Kunduz To improve quality and outcomes of health care by adapting and applying modern methods of quality improvement (QI) Coverage in Herat 1064500 Coverage in Parwan 253200 Coverage in Bamyan 161970 Seven Hospitals in Kabul. Estimated catchment is 3,449,800 out of approximately 4,000,000

  5. Intervention Package - Maternal Newborn Care Collaborative- Afghanistan ANC: Birth preparedness/ complication readiness; Tetanus; Iron/Folate ANC: Screening, stabilization and referral for complications (prep-eclampsia and other) Community Post-partum: Screening, stabilization, and referralof maternal and newborn complications (sepsis, etc.) Post-partum: Essential Maternal and Newborn Care; Danger sign recognition and care seeking ANC: Screening and management of pre-eclampsia/eclampsia Birth/Post-partum: Partogram; IP ; complications management (hemorrhage, eclampsia, sepsis, newborn asphyxia and LBW), FP (LAM; progestin-based oral contraceptives) BPHS ANC: Birth preparedness; Danger sign recognition, Tetanus Birth/Post-partum: AMTSL/ENC; IP; maternal/newborn monitoring and discharge Hospitals Improve Prevention and early detection of PPH Improve prevention and management of Birth Asphyxia Improve maternal/newborn postnatal care Improve Medical records Maternal/neonatal sepsis Eclampsia/ preclampsia Triage Obstrcuted labor …….

  6. Key Results from three Collaboratives

  7. Proportion of partographs completed (vital signs admission ; cervical dilation curve, fetal heart rate with a minimum of two points recorded (1389)

  8. Proportion of births for which 3 AMTSL elements performed (Oxytocine given at 1st minute after delivery, Cord traction, uterine fundal massage) (1389)

  9. Average compliance with resuscitation standards(1389)

  10. Proportion of births in which newborn put to breast within first hour after birth (1389)

  11. Proportion of mothers who were monitored post-partum according to standards (1389)

  12. CHWs monthly meeting at NK CHC ANC/PNC Counseling simulation

  13. Methodology Associates in Process Improvement (API)

  14. Basics of collaborative improvement QI team representative Multiple sites simultaneously testing changes, common indicators, peer learning about how to improve that area of care Collaborative-level sharing and synthesis of best practices Site-level summary Site-level testing of changes and analysis of results

  15. Keeping Quality Improvement Understood and Active at Different Levels 1- Assisted the MoPH develop strategy for improving quality in health care 2- Assisting the MoPH to establish a structure to implement and oversee 3- Partnering with others to educate 4- Spreading knowledge on quality and exposing leaders to best practices

  16. Senior Mgmt Leader Lead Change Improve…Advisors Lead Change MoPH Unit Provinces Quality Focal Point Quality Focal Point Hospitals === HFs Community QI teams QI teams

  17. Challenges • Low wages and therefore low commitment • Out of date/complicated admin procedure • Lack of female staff • Turn over of staff and implementing NGO • Lack of basic needs in HF (supplies, equipment) • Not matching reporting and monitoring system to the extent of expanded services • Security

  18. Thank you!

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