QUALITY ASSURANCE IN PRIMARY HEALTH CARE

1. QUALITY ASSURANCE IN PRIMARY HEALTH CARE ASIF IMAM, M.D. MARCH, 2011 SINA HEALTH EDUCATION AND WELFARE TRUST

2. THE ORIGINS OFSINA HEALTHCARE SYSTEMS STARTED AS A PROTOTYPE PRIMARY HEALTH FACILITY IN BALDIA TOWN, KARACHI IN 1998 OBJECTIVES : • To evaluate the existing primary healthcare systems in Pakistan • To develop an indigenous, practical, evidence-based, quality-managed, auditable primary healthcare system for developing countries

3. Vision • Quality primary healthcare should be accessible to everyone in our society SINA HEALTH EDUCATION AND WELFARE TRUST

4. Our quality mission TO DEVELOP A STANDARDIZED, QUALITY-MANAGED, INDIGENOUSLY COMPATABLE PRIMARY HEALTHCARE SYSTEM FOR WIDESPREAD APPLICATION IN PAKISTAN SINA HEALTH EDUCATION AND WELFARE TRUST

5. SINA Healthcare System And Quality Assurance SINA HEALTH EDUCATION AND WELFARE TRUST

6. DEVELOPMENT OF QUALITY MANAGEMENT COMPONENTS • STANDARD OPERATING PROCEDURES • QUALITY MANAGEMENT DOCUMENTS AND PROCEDURES • TRAINING OF STAFF IN THE STANDARDIZED SYSTEM • QUALITY AUDITING PROCEDURES AND TOOLS • REMEDIAL AND REPRIMANDING POLICIES ON AUDIT RESULTS

7. SINA HEALTHCARE QUALITY-MANAGEMENT COMPONENTS • DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY • PARAMEDIC TO PATIENT HEALTHCARE DELIVERY QUALITY • PHARMACY TO PATIENT SERVICE QUALITY • LABORATORY SERVICES QUALITY • INFECTIOUS DISEASE CONTROL / FACILITY HYGIENE QUALITY • MEDICAL INSTRUMENTS CALIBERATION / MAINTENANCE • FACILITY ADMINISTRATION / PATIENT SATISFACTION QUALITY

8. Recordkeeping System: Registration Card Patient Files SINA HEALTH EDUCATION AND WELFARE TRUST

9. DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY • DOCTOR RECRUITMENT CRITERIA • PRE-EMPLOYMENT ( INDUCTION) SYSTEM TRAINING • DOCUMENTING OF PATIENT CARE ON QUALITY MONITORING TOOLS • AUDIT OF DOCUMENTED PATIENT HEALTHCARE • ON-GOING ON JOB RE-TRAINING (CME) • REMEDIAL MEASURES OR REPRIMAND ON QUALITY AUDIT RESULTS

10. Employment System: • Doctors Selection Criteria: • Family Medicine experience • FCPS / MRCGP, prefered • Entrance Test • Pre-employment ( Induction) Training • To be system trained before doing clinics SINA HEALTH EDUCATION AND WELFARE TRUST

11. Candidate Evaluation Form

12. SINA CME SINA HEALTH EDUCATION AND WELFARE TRUST

13. Feedback on MCQ and SMS performance Monthly audit and 1-to1 teaching CME SMS Service X3/ week CME Half yearly 1-to-1 review and PDP development Monthly ½ day group teaching Pre-reading materials Learner-led sections Pre and post Session MCQs

14. Recordkeeping System • Patient Files • Patient Registration Cards • 14 Algorithmic Protocols Compromise On Quality SINA HEALTH EDUCATION AND WELFARE TRUST

15. FEVER PROTOCOL

16. SINA Audit System SINA HEALTH EDUCATION AND WELFARE TRUST

17. Monthly Doctors’ Audit: • Protocol based audits • Clinic based audits • Proper one to one feedback to every doctor • Review for improvement every month • Proper record keeping SINA HEALTH EDUCATION AND WELFARE TRUST

18. Protocol Based Audit

19. Clinic Based Audit

20. Half Yearly Evaluation Of Doctors • Every six months • Record of the last 6 months performance • One to one feedback • Discuss about the weaknesses and solutions for improvement • Personal development planning forms SINA HEALTH EDUCATION AND WELFARE TRUST

21. Half Yearly Evaluation Form

22. PDP form

23. SINA Paramedics Evaluation SINA HEALTH EDUCATION AND WELFARE TRUST

24. SINA Health Manpower Training Program : Internal • Lack of quality human resource • Training upon employment • Continuous education • Periodic exams & evaluation • Performance feedback

25. SINA Paramedics OSCE SINA HEALTH EDUCATION AND WELFARE TRUST

26. OSCE CHECKLIST

27. TPR Station:

28. Dressing station:

29. Dispensing station:

30. SINA Pharmacy System SINA HEALTH EDUCATION AND WELFARE TRUST

31. SINA Pharmacy Services • Standard Formulary • GMP Certified Medicines • Central Purchasing • FIFO Inventory Control • Hygienic Practices • Trained Staff • Quality Control SINA HEALTH EDUCATION AND WELFARE TRUST

32. SINA Laboratory Services SINA HEALTH EDUCATION AND WELFARE TRUST

33. LABORATORY QUALITY CONTROL • Internal Assessment • Continuous quality improvement • External Assessment • Monthly comparative testing with AKUH lab • Adherence to SOP manuals • Quarterly audits

34. SINA Infrastructure Maintenance SINA HEALTH EDUCATION AND WELFARE TRUST

35. Medical Centre Audit: • Monthly audit by head office staff • Follow proper checklist • All registers and written documentations are checked • Medical equipments checking • Corrective actions taken SINA HEALTH EDUCATION AND WELFARE TRUST

36. MEDICAL CENTRE AUDIT CHECKLIST

37. SINA Infectious Disease Control System SINA HEALTH EDUCATION AND WELFARE TRUST

38. Standard Operating Procedures • Instrument Sterilization  • Clean the dirty instruments with cotton swabs. • Wash with tap water. • Dip the instruments in antiseptic solution for 5-10 min. • Wrap the instrument in cotton and keep in the instrument tray • Keep the tray in sterilizer at 150 F for 20 min. SINA HEALTH EDUCATION AND WELFARE TRUST

39. SINA Waste Management Service Clinical Waste Segregation Red Bags Hazardous Waste Danger Box Sharps & Needles Green Bags General Waste SINA HEALTH EDUCATION AND WELFARE TRUST

40. SINA Waste Management Service • 78 km twice a week BALDIACLINIC MACHAAR CLINIC CDGK INCINERATOR SABZIMANDICLINIC HIJRAT CLINIC SINA HEALTH EDUCATION AND WELFARE TRUST

41. SINA Management System SINA HEALTH EDUCATION AND WELFARE TRUST

42. SINA Management System Monthly Meeting of Clinical Coordinator and Clinic Manager Solutions Provided To Clinic Manager Minutes By Clinic Managers Clinical Coordinator Trustees and Operation Manager SINA HEALTH EDUCATION AND WELFARE TRUST

43. Thankyou For Listening SINA HEALTH EDUCATION AND WELFARE TRUST