PRACTICUM SUMMARY REPORT

Transcription

1 PRACTICUM SUMMARY REPORT Name: KOSSIVI AGBELENKO AFANVI, MD, CMgr, MCMI, PAHM Team Members: COMLAVI TSOMO ESSILIVI, RN, Lacs Health District Tuberculosis Focal Point; KOKOU MAWULE DAVI, MD, MPH, National Tuberculosis Program Coordinator Prof. YAWO DZAYISSE ATAKOUMA, Head of Pediatrics Department, UNIVERSITE DE LOME Project Title: Improving Lacs Health District Tuberculosis Program Performance University/Organization Name: UNIVERSITE DE LOME (TOGO) Health System Sponsor Name: Lacs Health District Aim of project (1-2 sentences) Our aim was to improve Lacs Health District Tuberculosis Program performance by improving the public health system related to TB patients treatment. Specifically, we wanted at least 85% treatment success rate of pulmonary TB patients in Lacs Health District by February 28th, Planned changes tested (2-3 sentences) Before the project, a systems and dialogic analysis of the public health system related to TB patients treatment revealed that it was not well-performing (weak coverage and quality of TB services, weak-functioning TB health information system, weak-performing health workforce, weak availability of HIV tests and antiretroviral for TB patients and low degree of patients participation in their care). For this project, the system was redesigned to correct the identified weaknesses. We will monitor the effectiveness of these changes using PDSA cycles. Predictions (2-3 sentences) By successfully implementing this project, we expect to have a more sustained public health system which definitely can achieve its goal: save lives. We will use a systems and dialogic approach to redesign and pilot the public health system. This novel approach is expected to better empower TB stakeholders to deal with their health condition. Results Present your results with a graph(s).

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3 Summary of results (3-4 sentences): By combining our approach which we called the empowered DOTS (edots) to systematically putting TB-HIV coinfected patients under ART and asking for bacteriological culture and PCR in presence of cough after two months of a well observed treatment, we improved our TB program performance. We increased TB patient success rate from 80 percent to 95 percent between February 2012 and July 2013 in Lacs Health District in Togo. The lethality rate dropped from 13 percent to 5 percent, the failure to follow-up rate dropped from 3 percent to zero percent and the proportion of TB-HIV co-infected patients under ART increased from 24 to 100 percent. Learning (4-5 sentences) Comparison of questions, predictions, and analysis of data:

4 In our first PDSA, we were looking for which combinations of changes could help achieve at least 85 percent of treatment success rate. We predicted to achieve at least 85 percent of TB patients treatment success rate, 5 percent or less lethality rate among TB smear positive patient and 4 percent or less failure to follow-up rate among TB patients every month. The average treatment success rate moved from 80 percent to 90 percent between February and September 2012, the average lethality rate dropped from 13 percent to 5 percent (the prediction level) and the average failure to follow-up rate dropped to 2 percent. From April 2012, no failure to follow-up was noticed among TB patients for six consecutive months. We noticed that globally, we surpassed our predictions but also realized that the system could not sustain without decreasing TB-HIV co-infection lethality. In PDSA cycle # 2, we tried to know if systematically putting TB-HIV co-infected patients under antiretroviral treatment could help increase more TB patients' treatment success rate. We predicted to achieve at least 95 per cent the TB patients' treatment success rate by increasing the proportion of TB-HIV co-infected patients under antiretroviral treatment (ART). The average treatment success rate increased again from 90 percent to 94 percent. The prediction was not met due to treatment failure as a result of drug resistance. The proportion of TB-HIV co-infected patients under ART increased from 53 to 75 percent. Based on the knowledge that in presence of cough after two months of a well observed treatment, treatment failure can be suspected and a PCR and bacteriological culture could be asked for, we ran a third PDSA cycle after which we achieved on average 95 percent treatment success rate, zero percent treatment failure and 100 percent proportion of TB-HIV co-infected patients under ART. Impact on systems (3-4 sentences) Discuss the project s significance on the local system and any findings that may be generalizable to other systems: By raising TB patients treatment success rate, we allow hope to eliminating TB in Lacs Health District in the future. Successful treatment of individual cases reduces TB morbidity and mortality; reduces the number and period of infectious cases; and prevent the emergence of resistant strains. Other districts could use our tested approach, called the empowered DOTS (edots), and combine it to systematically putting TB-HIV co-infected patients under ART and asking for bacteriological culture and PCR in presence of cough after two months of a well observed treatment to improve their TB program performance. Conclusions (3-5 sentences) Summarize the outcome of the project. Is this project sustainable? What are the requirements for sustainability? Health systems performance at District level depends on factors such as the closeness of services to population; skilled workforce; ability to collect and analyze data and use information for action; population empowerment and good management and improvement capabilities of management team especially the Public Health Director. High TB patients success rate depends also on the availability of antiretroviral drugs. We strongly recommend every District Health Management Team member to increase his knowledge in improvement capabilities. Reflections/Discussions (5-7 sentences) Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team? The success of the project was based on the systems analysis of the existing health system and the management and improvement capabilities of management team especially the Public Health Director. Improvement capabilities helped to understand variation and team management or (better) stakeholders management strengthens achievements from each step. Undoubtedly medical management requires strong clinical management competencies particularly clinical status monitoring during care to depict early signs of treatment failure to be managed. Population empowerment should be the future focus of health system to achieve high and sustainable performance. Health system should be managed as a system, taking into account all the six building blocks.

5 By signing this document (electronic signature is acceptable), I attest that the information provided by the learners in this project is accurate. LEARNER(S): Dr. KOSSIVI AGBELENKO AFANVI PUBLIC HEALTH MANAGEMENT FACULTY SPONSOR: HEALTH SYSTEM SPONSOR (if different from faculty sponsor): Prof. YAWO DZAYISSE ATAKOUMA Institution: Pediatrics Department, UNIVERSITE DE LOME Institution: AUTHORIZATION Do the learners, faculty sponsor, and health system sponsor authorize this project for publication at X Yes No