N Ramawela- QI PM NDOH Date: 21 February...
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TB Quality Improvement - South Africa N Ramawela- QI PM NDOH Date: 21 February 2018
Transcript of N Ramawela- QI PM NDOH Date: 21 February...
TB Quality Improvement - South Africa
N Ramawela- QI PM NDOH
Date: 21 February 2018
TB QI project concept: Background
Summary
▪ South Africa is one of the 30 high burden TB countries
– High mortality 181 per 100 000 population among HIV positive TB
patients
– High incidence of All TB and MDR-TB at 781 and 34 per 100 000
population
▪ TB Strategic Plan 2017-2022 aim
– Decrease deaths due to TB by 50%
– Decrease incidence of TB by 30%
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▪ Department of health has adopted
▪ 90-90-90 targets for 2020
▪ To achieve these ambitious targets▪ a reliable system to find
▪ start treatment
▪ and retain in care the great majority of existing and
newly diagnosed patients with TB
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Criteria for province selection
TB Burden by province: 2008-2014
4
0
20000
40000
60000
80000
100000
120000
140000
EC FS GP KZN LP MP NW NC WC
2008
2009
2010
2011
2012
2013
2014
Criteria for district selection
High Medium Low
TB Case Notification Rate (2015)¹ > 1 000 500 - 1 000 < 500
Estimated PLHIV² >100 000 100 000 - 50 000 <50 000
TB/HIV Comorbidity4
>60% 30-60% <30%
Rifampicin Resistant TB Lab dianosed³ (2015) >500 100 - 500 <100
MDR-TB Lab diagnosed³ (2015) >500 100 - 500 <100
Notifications DS-TB4 >10 000 5 000 -10 000 < 5 000
High burden provinces (KZN, EC,WC,GP)
Other criteria used
Presence of a Technical Partner with experience in QI
Urban/ rural mix
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Phase 1A: Dem./learning in 10 sub-districts
Phase 0: Set-up
Launch May 2017
May 2018
May 2019
May 2020
May 2021
Phase 1B: Testing scale up across 9 full
districts
Phase 2A: Dem./learnin
g 43 subdistricts
Phase 2B: Taking remaining 43 full districts to full scale
Project design
KEY ACTIVITIES
▪ Engagement of Provincial and District
management
oBuy-in by DHMT in all 9 districts
▪ Development of implementation guides – clinical,
QI, Data
▪ QI capacity building for provincial, district and
sub-district managers and partners
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▪ Quarterly Sub-district Learning Sessions/
collaborative
o19 Learning collaboratives for facility clusters
conducted
o715 sub district, district and provincial
staff trained
o223 Facilities are implementing QI in 10 sub
districts
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▪ Monthly coaching and mentoring visits
o Facility supervision rate is 86%
▪ Data Quality Audits
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THANK YOU
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