Role of Quality Assurance in increasing program efficiency: Evidence from an ORBIS supported project in rural Bangladesh. Lutful Husain, Abu Raihan, Mahsina Afroz IAPB 9th GA, Hyderabad, September 2012
Purpose: Islamia Eye Hospital in Bangladesh is implementing a collaborative project with support of ORBIS International to deliver quality cataract and refractive error service for the rural people by establishing three eye hospitals in rural districts of Bangladesh. The purpose of this study is to share the impact of the introduction of quality assurance system in the project to improve clinical service and its ultimate effect on program efficiency and sustainability.
Method: An evaluation was carried out in December 2010 to assess the progress of the project, appraise the quality of clinical services and recommend strategies for future improvement and sustainability. Some steps were taken following evaluation, like: • Introduction of quality assurance strategies • Reinforcement of monitoring and supervision function • Training to ophthalmologists in cataract surgery through Hospital Based Programs • Introduction of standard protocols for cataract surgery and follow up care • Development of effective outreach programs by reviewing current practices • Intensification of the use of IEC/BCC activities
Method (Cont’d): Hospital medical record sheet of 73 cataract surgical cases operated in July 2010 (pre-evaluation phase) and 69 cataract surgical cases operated in July 2011 (post-evaluation phase) were collected from one of the three newly established district hospitals and findings were analyzed.
Results (Cont’d): • Medical documentation including demographic information , operation notes and post-operative follow up findings were not well recorded and found missing in some cases during pre-evaluation phase while in post-evaluation phase all necessary information in medical case sheet were well maintained. • The number of walk in cataract patients attending the hospital rose double during the study period which contributed to significant cost recovery and revenue generation.
Conclusion: Introduction of quality assurance practice and effective monitoring of project activities resulted in delivery of high quality surgery with maintenance of good medical records for clinical audit. This contributed in increasing the number of surgical walk-in patients and had an impact on enhancing program effectiveness.