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

2. THE ORIGINS OF SINA 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
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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. Half yearly 1-to-1 review
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. Patient Registration Cards 14 Algorithmic Protocols
Recordkeeping System
Patient Files
Patient Registration Cards
14 Algorithmic Protocols
Compromise On Quality
SINA HEALTH EDUCATION AND WELFARE TRUST

15. FEVER
PROTOCOL
Don’t get too carried away by the wizzy graphics – if you use too many types of movement of the text people start focusing on what’s going to happen next rather than the content of the slides themselves

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
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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. Clinical Waste Segregation
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
SABZIMANDI CLINIC
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
Just ‘thank you for listening’ is enough I think
SINA HEALTH EDUCATION AND WELFARE TRUST