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1 Leading Change From the Front Line In Afghanistan USAID Health Care Improvement (HCI) Project University Research Co., LLC Center for Human Services.

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Presentation on theme: "1 Leading Change From the Front Line In Afghanistan USAID Health Care Improvement (HCI) Project University Research Co., LLC Center for Human Services."— Presentation transcript:

1 1 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, Amsterdam

2 USAID HEALTH CARE IMPROVEMENT PROJECT Outline Brief Country Profile What and Where URC Activities at 4 Levels: 1)Hospital Level 2)Health Facility Level (BPHS) 3)Community Level 4)National level Keeping Quality Improvement Understood and Active at Different Levels

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

5 USAID HEALTH CARE IMPROVEMENT PROJECT Intervention Package - Maternal Newborn Care Collaborative- Afghanistan Service levelPhase OnePhase Two ANC: Birth preparedness/ complication readiness; Tetanus; Iron/Folate ANC: Screening, stabilization and referral for complications (prep-eclampsia and other) Post-partum: Essential Maternal and Newborn Care; Danger sign recognition and care seeking Post-partum: Screening, stabilization, and referralof maternal and newborn complications (sepsis, etc.) Community BPHS Hospitals ANC: Birth preparedness; Danger sign recognition, Tetanus Birth/Post-partum: AMTSL/ENC; IP; maternal/newborn monitoring and discharge Improve Prevention and early detection of PPH Improve prevention and management of Birth Asphyxia Improve maternal/newborn postnatal care Improve Medical records 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) Maternal/neonatal sepsis Eclampsia/ preclampsia Triage Obstrcuted labor …….

6 6 Key Results from three Collaboratives 6

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

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

9 USAID HEALTH CARE IMPROVEMENT PROJECT Average compliance with resuscitation standards (1389)

10 USAID HEALTH CARE IMPROVEMENT PROJECT Proportion of births in which newborn put to breast within first hour after birth ( 1389)

11 USAID HEALTH CARE IMPROVEMENT PROJECT Proportion of mothers who were monitored post- partum according to standards (1389)

12 USAID HEALTH CARE IMPROVEMENT PROJECT CHWs monthly meeting at NK CHC ANC/PNC Counseling simulation

13 USAID HEALTH CARE IMPROVEMENT PROJECT

14 Associates in Process Improvement (API) Methodology

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

16 USAID HEALTH CARE IMPROVEMENT PROJECT 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

17 USAID HEALTH CARE IMPROVEMENT PROJECT === Lead Change MoPH Unit Provinces Quality Focal Point Hospitals HFs Leader QI teams Improve…Advisors Senior Mgmt Community

18 USAID HEALTH CARE IMPROVEMENT PROJECT 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

19 USAID HEALTH CARE IMPROVEMENT PROJECT Thank you!


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