MUNDRI PHCC_GPPresentP_2022_02_WK22.pptx

principles of epidemiology

1. Mundri Team Mundri PHCC GSM CALL on Missed Appointments Tracking Date: 07/03/2022 Presenter Bishop Elinana -CHSO

2. Mundri Team Participants Bishop Elinana -CHSO. Margret Hamed-CFO. Lukere Luke-MOH FO.

3. Mundri Team Dashboard Week Clients with Appointment Came on appointed date Missed Appointment Missed Appointment% Clinic Load Clinic Load% WK13 5 1 4 80% 6 120% WK14 5 1 4 80% 6 120% WK15 1 1 100% 4 400% WK16 3 3 100% 10 333% WK17 5 5 100% 8 160% WK18 1 1 100% 16 1600% Wk19 5 5 100% 12 240% WK20 4 4 100% 7 175% WK21 8 1 7 88% 15 188% WK22 16 1 15 94% 26 163% Total 53 4 49 92% 110 208% Dashboard Week Clients with Appointment Came on appointed date Missed Appointment Missed Appointment% WK13 11 1 10 91% WK14 5 1 4 80% WK15 8 6 2 25% WK16 7 7 100% WK17 8 5 3 38% WK18 3 1 2 67% Wk19 6 1 5 83% WK20 7 1 6 86% WK21 8 8 100% WK22 19 1 18 95% Total 82 17 65 79% PEPFAR Dashboard Data Facility Recreated Data

4. Mundri Team

5. Observations-Review of Clients files to ascertain their attendance status. 65 files of clients who missed appointments were reviewed. 52 (80%) Clients returned but not updated in the appointment log. 07 (11%) Clients were still missed appointments. 06 (09%) clients were interruptions in treatment. Mundri Team

6. Review of files for Presence of documented phone number. Missed Appointments 7 Missed appointments 3 (43%) Clients had phone numbers. 4 (67%) clients had no phone numbers. Interruptions in treatments 6 Interruptions in treatment 3 (50%) Clients had phone numbers. 3 (50%) Clients had no phone numbers Mundri Team

7. Review of Clients’ files for presence of documented landmarks. Missed Appointments 7 missed appointments. 2 (29%) Clients had landmarks. 5 (71%) clients had no landmarks Interruptions in treatments 6 missed appointments. 2 (33%) Clients had landmarks. 4 (67%) clients had no landmarks Mundri Team

8. Mundri Team PROBLEM STATEMENT 92 %(49/53) Clients missed appointments in WK13-WK22 FY22 in Mundri PHCC.

9. 92% Clients miss2d appointments in WK13-WK20 FY22 in Mundri PHCC. Clients Providers Fish bone diagram (Root cause analysis) No phone contacts (7 clients). No documented linkage to COVs (13 client) Irregular update of the appointment log with respect to files (52 clients). No appointment reminder log in use Mundri Team

10. Mundri Team AIM STATEMENT To reduce missed appointments from 92% to 40% by end of march 2022 in Lui Hospital.

11. Driver ’s diagram Mundri Team

12. F ocusing matrix IMPORTANCE 1 (LEAST) 2 3 4 5 (MOST) EASE OF IMPLEMENTATION 1 (HARDEST) 2 3 Initiate outreach activities with focus on VL sample collection Address barriers to adherence Train counselors on VL sample collection Generate and implementation supportive supervision plan Physically link and document COVs linkage Regular review and update of appointment log Provide phone call reminder Team to conduct and document phone call reminders Community ART refill through CSO providers Community refill. Extra travel refill. Counseling/awareness for clients on HIV. Adherence counseling/peer support. Counseling on adherence benefits. 4 Mentorship on EAC. Update address with clear landmarks and trace using COVs. Phone call reminders and through COVs. Adhere to TLD algorithm Review & print SOPs Establish VL sample collection point in PHCC Triage clients for VL Daily and weekly data checks MMD Create new TX centers Strengthen community refills Initiate inter facility tracking of HVL clients Provide data collection tools 5 (EASIEST) Mundri Team

13. Mundri Team Action Plan Problem Statement : 92% Clients missed appointments in WK13-WK22 FY22 in Mundri PHCC . Aim : To reduce missed appointments from 92% to 20% by the end of march 2022 in Mundri PHCC . Root Causes Change idea Responsible personnel Timeframe Expected outcome Implementation progress status Date Root Causes Change idea Indicator Responsible personnel Timeframe Expected outcome 07/03/2022 No phone contacts (7 clients) Community ART refill through CSO providers. # Clients refilled in the community Bishop-CHSO 15/03/2022 Follow up 31/03/2022 Clients refilled No documented linkage to COVs (13 clients) Physically link and document linkage to COVs # Clients linked to COVs Bishop-CHSO 15/03/2022 Follow up 31/03/2022 Clients linked to COVs Irregular update of appoint. log with respect to files (52 clients) Regular review and update of appoint. log # Clients with appointments updated Joe-Data Clerk Bishop-CHSO 08/03/2022 Follow up 31/03/2022 Appointment log completely and correctly updated

14. Mundri Team Action Plan Problem Statement : 92% Clients missed appointments in WK13-WK22 FY22 in Mundri PHCC . Aim : To reduce missed appointments from 92% to 20% by the end of march 2022 in Mundri PHCC . Root Causes Change idea Responsible personnel Timeframe Expected outcome Implementation progress status Date Root Causes Change idea Indicator Responsible personnel Timeframe Expected outcome No appointment reminder log in use Provide phone call reminder log # phone call reminder log Bishop-CHSO 15/03/2022 Follow up 31/03/2022 Phone call reminder log provided Team to conduct and document phone call reminders # of documented phone call reminders Bishop-CHSO 15/03/2022 Follow up 31/03/2022 Phone call reminders conducted and documented.

15. Mundri Team S/no. WK10 FY22 Action item KRP Time frame Follow up status 01 Expedite the recruitment of OPD Counselor (IP proposed PMTCT Counselor) Dr Rama 05/01/2022 Follow up 15/01/2022 02 Erect temporary OPD HIV risk screening and testing room Dr Rama 15/03/2022 Follow up 30/01/2022 03 04 05

16. Mundri Team Challenges Recommendations Long distance Community ART Refill Transport means/fuel shortage Use the shared bike and place fuel/service requisition Challenges

17. Attendance list S/NO Name Title/Position Status 01 02 03 04 05 06 07 08 09 10 Mundri Team

18. Thank you Aru’boyah Mundri Team