URC-SWAZILAND MONTHLY NEWSLETTER...Josephine Jonato, Laboratory Technologist, present-ing her...

Improving systems to empower communities

FOREWORD BY THE COUNTRY DIRECTOR

“I wish to congratulate the staff and URC

and MOH counterparts for very produc-

tive months of June and July 2014. We

witnessed major accomplishments.

Starting with the technical support pro-

vided to the Swaziland health Laboratory

Services through CDC HIV and TB, June

started with a bang. Five laboratories that

have been working on strengthening their

quality management systems through the

Stepwise Laboratory improvements to-

wards accreditation (SLIPTA) which were

presented to the African Society for La-

boratory Medicine external laboratory

audits achieved SLIPTA stars on their

journey to accreditation. The hard work

by our staff and the SHLS staff paid off. I

would like to applaud all the laboratories

that attained stars of accreditation. The

National TB lab can be singled out for

additional accolades, attaining 3 stars and

being recommended to work towards full

accreditation assessment within the next

12 months.

The USAID Applying Science to

Strengthen and Improve Systems (ASSIST)

project took the advantage of the FIFA

World cup in Brazil June 13-July 12, 2014,

to launch a campaign of Kick TB out of

Swaziland. Working closely with the Na-

tional TB Control Program and University

Research South Africa, radio, print and

social mobilisation activities were con-

ducted. I wish to congratulate the team on

the successful in-house quarterly review

meeting where facility and regional level

projects continued to critically review and

assess the outputs and outcome of the

year. The Quarterly Review Meeting and

Planning workshops also provided a forum

for staff to reflect on what worked and

what did not, in order to enhance im-

provements in the following year. Other

learning opportunities included the model

clinics collaborative learning & sharing

sessions.

For the new staff who joined us in the last

two months, welcome to URC.”

URC-SWAZILAND MONTHLY NEWSLETTER

June-July 2014 Issue

10 August 2014 Volume 1, Issue 6-7

Inside this issue:

July Staff QRM: Impacting

Health Systems and Health

Outcomes

2

Kick TB Competition:

Health Education that En-

courages Behavioral Change

Towards TB Issues

3

Ngowane Community Dia-

logues on TB, HIV NCDs &

Fitness Games for the Elder-

ly: “Shukuma Gogo”

4

Biosafety Training for Phle-

botomists: Improving Capac-

ities on Evolving Health and

Safety Requirements

5

Five Swaziland Laboratories

Awarded Stars of Accredita-

tion

6

TB/HIV Management &

Guidelines Training: Keeping

Health Care Workers Up to

Speed with Current Stand-

ards

8

Training of Trainers (TOT)

on Quality Assurance/ Quali-

ty Improvement: Improving

Capacity of Healthcare

Workers to Apply Quality

Improvement

9

The New Reigning QRM

Queen

9

New Additions to the URC

Family

10

Learning from a Team’s Own

Experience

12

Other Activities 13

URC Swaziland Country Director, Dr Samson Haumba.


practices which could be implemented in

order to carry out successful interventions.

Newly introduced in this quarter’s QRM

was the displaying of storyboards. A total

of 15 Quality Improvement (QI) interven-

tion storyboards illustrating tested interven-

tions and change were displayed from the

different health facilities supported by the

team.

The Project Support Team (PST) was for

the first time present in the July QRM.

Previously, the need for having the PST

team was under rated, however after this

QRM it was realised that they also play a

vital role in carrying out some of these

activities.

Page 2 Volume 1, Issue 6-7

JULY STAFF QUARTERLY REVIEW MEETING: Impacting Health Systems and Health Outcomes

Each quarter the University Research Co.,

LLC (URC-Swaziland) staff Quarterly Re-

view Meeting (QRM) continues to evolve

into new and better practices. In this quar-

ter the QRM fell on the 28th-29th of July

2014, at the Mountain Inn Hotel, which has

since became the main preference for

such workshops. The theme for this work-

shop was, “Impacting Health Systems &

Health Outcomes”.

Taking some time to focus on work done

can count as a beneficial and necessary

practice. The QRM promotes this practice,

allowing staff to track where they started,

whether they are going about it the right

way and whether targets are being met.

The presentations from the different pro-

jects USAID ASSIST and CDC URC-Lab

project were very informative and allowed

for open discussions with participants.

These discussions became beneficial as it

allowed the other projects to understand

on-going activities within the organisation.

The URC staff was also able to share best

The workshop does not only serve the

purpose of assisting staff to identify areas

of collaboration and to share best practic-

es, which could help with project sustaina-

bility. It further helps bring staff members

closer, which helps improve productivity

due to teamwork. The open discussions

have resulted to a number of noticeable

improvements in project results when

compared to the previous quarter.

It is in no doubt that the best practice of

holding QRM workshops is vital in the car-

rying out the URC mission, strengthening

health systems and impacting favourable

health outcomes in Swaziland.

JULY

Let’s move a little… energizer which helped keep participants fo-cused and energetic.

Participants seated in a semi-circle jotting down their comments during the presentation.

Josephine Jonato, Laboratory Technologist, present-ing her storyboard during the QRM.


The Kick TB competition started on the

16th of June to the 14th of July 2014. This

competition had targeted the FIFA World

cup as well as Men’s Health month as the

key events to draw the attention of the

public on TB issues. The theme of the

campaign was therefore, “Kick TB: Find

TB. Treat TB. Cure TB.”

The competition involved listening to radio

messages on TB topics, including IPC,

diagnosis, treatment, TB and alternative

medicines traditional healers and TB

symptoms. The audience was expected to

listen to the TB messages then answer

one of three simple questions related to

the radio messages through instant mes-

saging. Radio served as an appropriate

medium to teach about TB issues because

it maintains a high listenership of about

90% of the country’s population.

Response to the competition started off

slow and then improved after promoting

the competition on TV at the breakfast

show, “Kusile”. The visit to the show al-

lowed the USAID ASSIST project team to

go beyond just promoting the competition,

but to also provide health education on

basic TB issues. After the show the public

became responsive and even took the

opportunity to ask personal questions.

The competition entries closed on the 14th

of July and by then a total of 244 people

had entered, double the number of people

that were expected. Towards the last two


KICK TB COMPETITION: Health Education that Encourages

Behavioural Change towards TB Issues

weeks the answers improved with less

incorrect responses adding up to 228. 71

contestants out of that total answered all

three questions correctly, which gave them

a chance to win one of two android smart

phones. The other 157 contestants stood

to win a shopping voucher worth E500 and

E300.

On the 16th the project team, visited the

Kusile Breakfast TV Show where there

was a live draw. The winners were drawn

from the buckets by the presenter and the

contestants selected were immediately

called, which no doubt the competition

kept interesting. The TB messages

reached the audiences at home, achieving

its intended success.

The official ‘KICK TB’ launch was marked by a soccer match in Nhlangano. The goal keeper URC Swaziland Country Director, Dr Samson Haumba and

striker the Shiselweni Regional Administrator, Themba Masuku.

Shiselweni RA, Themba Masuku exemplary step which moved the public to also screen for TB.

JULY


In Swaziland the elderly are normally

considered the wisdom of communities,

which is why a majority of people consult

with them before making decisions. Ac-

cess to health care and imparting

knowledge to them health issues affect-

ing communities is beneficial to them and

their households. On the 12th of June

2014, the Swaziland USAID ASSIST

Project team partnered with Ngowane

Clinic and community leaders, hosted a

one day fitness event, targeting elderly

women, referred to as ‘Bogogo’ in siSwa-

ti. This event was themed, “Shukuma

Gogo”, loosely translated as “Move elder-

ly women”.

This event packed with activities no doubt

left the 60 elderly women aged between

the ages of 55 – 89 years exhausted, but

fit and filled with information pertaining to

TB, HIV and NCDs. The sessions began

with health educational discussions,

which allowed the elderly in attendance to

share their views and ask questions

where needed.

Even though as elderly people the wom-

en were quite receptive to what they were

being taught even though it meant chang-

ing some of their custom practices. For

example, as per the Swazi custom, a

dead family member is normally bathed

and dressed by the elderly, even if they

are from the morgue, before their funeral.

By the end of the dialogues a majority of

the participants were now against the

practice aware of all the risks of infection.

The second session in the day’s pro-

gramme involved engaging participants

In some of the games and exercises

included the egg race, running, coordina-

tion games and games that encouraged

healthy eating. By the end of the day all

the ‘Gogos’ were screened and 16 tested

positive. Seven produced spot sputum

and only one out of that group was diag-

nosed with TB and initiated on treatment.

Among the 16 suspects, 4 were MDR-TB

contacts thus GeneXpert and culture was

ordered for them. 300 TB/HIV and Infec-

tion Prevention and Control (IPC) Behav-

ioural Change Communication (BCC)

were distributed by the end of the day.

NGOWANE COMMUNITY DIALOGUES ON TB, HIV NCDs & FITNESS GAMES

FOR THE ELDERLY WOMEN: “Shukuma Gogo”


Having events that focus on specifically

on key population and risk groups helps

them understand the information impart-

ed to them better. This is particularly true

because they become comfortable with

asking questions freely, especially those

that touch directly on their lives. One old

women said “Maye nente kona ke

kusibita sodvwa ngoba bese siyesaba

lokukhuluma embikwe bantfu laba-

kakhulu ikakhulukati bobabe” Meaning

“ You did well by calling us as a sepa-

rate group because we tend to be shy

in the presence of other groups of

people especially men “

The elderly women holding up their BCC materials after an educational

day.

URC TB /HIV Coordinator, facilitating dialogues with the elderly community members.

Gogos versus Ngowane Senior Nurse, Nokwakhe Mkhumane racing to the finish

line.

The Gogos showed how fit they are during the egg race.

JUNE


A number of mini laboratories had phlebotomists that

had inadequate knowledge to enable them implement

biosafety requirements based on the World Health Or-

ganisation (WHO) Biosafety Manual and the ISO 15189,

15190 and 22870. To help improve their capacity, on the

27th-29th of June 2014, at Sibane Hotel, training was held

specifically for 23 phlebotomists from different health

laboratories around the country

The main goal of the training was to improve health and

safety in the mini laboratories considering the number of

hazards they are exposed to while carrying out their du-

ties. The biosafety training covered comprehensive as-

pects of Biosafety, fire safety, Infection Prevention Con-

trol (IPC) and waste management in efforts to keep up

with the evolving health and safety requirements.

For a training that was first of its kind, the pre and post

test results revealed that there was some knowledge

gained from the training. The lowest score for the pre-

test was 25% and the highest mark was 75%. After a

number of presentations that also included practical

sessions the lowest score recorded from the post test

was 56% and the highest was 100% showing a remark-

able gain in knowledge

At the end of the training the Swaziland Health Labora-

tories Services (SHLS) Chief Technologist Representa-

tive expressed thanks to the CDC Lab project for mak-

ing this training possible, which would help improve the

skills and practices of the phlebotomists in the labs.


BIOSAFETY TRAINING FOR PHLEBOTOMISTS: Improving Capacities on Evolving Health and Safety

Requirements

Group of URC staff and phlebotomists from different facilities posing after the workshop .

JUNE


Volume 1, Issue 6-7 Page 6

FIVE SWAZILAND LABORATORIES AWARDED STARTS OF ACCREDITATION

After countless months of hard towards laboratory

accreditation, on the13thth June 2014, five of the

country’s laboratories were awarded stars of ac-

creditation by the African Society for Laboratory

Medicine (ASLM).

This counted as an important landmark for Swazi-

land, as it is 50% close to accreditation. These

results placed the country at a recognisable aver-

age than other African countries though hosting

audits for the first time. This was announced dur-

ing a debriefing meeting at the Mbabane Govern-

ment Laboratory complex following the conducted

external laboratory audits.

The audits were conducted in collaboration with

the WHO AFRO office and the African Society for

Laboratory Medicine. The auditing process fo-

cused on 12 criteria, totalling to an overall score of

250. The five laboratories included:

Central Laboratory – Scored 156 (2 Stars)

Pigg’s Peak Hospital Laboratory – 169 (2

Stars)

National Molecular Reference Laboratory –

169 (2 Stars)

Mbabane Government Laboratory – 171 (2

Stars)

National TB Referral Laboratory – 198 (3

Stars)

This approach was embraced in an effort to

strengthen national laboratory services in stepwise

manner by providing graduated levels of perfor-

mance recognition towards a long term fulfilment

of the ISO 15189 standard. This was done through

CDC lab project with technical support by the Uni-

versity Research CO., LLC (URC) in collaboration

with the Infectious Disease Institute (IDI).

Also announced during the meeting were the 6

newly certified ASLM internal audits who are now

qualified to conduct laboratory audits. These are

namely Rogers Kisame, Cinisile Ndlangamandla,

Philton Ndzinisa, Anafi Mataka, Gcina Dlamini,

Nokuthula Magongo who are all affiliated with the

countries laboratories.

URC, MOH, IDI and ASLM team posing after the debriefing session at the Mbabane Government Laboratory.

JUNE



Words by URC Country Director, Dr Samson

Haumba

The CD applauded the awarded stars acknowledging

that it has indeed been an effective process which

started in 2011 as well as the newly recruited internal

audits. He further thanked the Swaziland Ministry of

Health for providing the opportunity to work with them

in building the capacity and quality of the country’s

laboratories.

Words by Director of Health Services, Dr, Vusi

Magagula

When I was first appointed as Director of Health Ser-

vices, laboratories in the country t needed the most

attention. Therefore without a doubt I am proud that

they have since improved to the point that all the

audited labs achieved stars of accreditation. He add-

ed that, internal audits are important, because it will

help keep everyone on their toes, pushing them to

work hard.

Score s and stars that were given to the five laboratories by the ASLM auditors


On the 23rd to 27th of June 2014, the

USAID ASSIST project held training at

Lugogo Sun Hotel targeting health care

workers from TB diagnostic sites and non

-diagnostic sites. The training was on TB/

HIV management and guidelines. This

training key focus was to introduce the 26

participants to the TB manual with current

national and international guidance in the

diagnosis, management and control of TB

and TB/HIV co-infection. This training is a

5 days training covering seven modules.

Each day was filled with knowledge

packed presentations by different facilita-

tors who are expert TB/HIV trainers well

equipped in their field of work. The first

day focused on three modules the epide-

miology of TB, transmission and Patho-

geneses as well as clinical diagnosis of

TB. The second day was especially de-

signed to equip participants with laborato-

ry TB diagnosis knowledge. On this day

the participants had various discussions

of improvement points about the transpor-

tation of samples and results.

TB/HIV MANAGEMENT & GUIDELINES TRAINING: Keeping Health Care Workers Up To Speed with Current Standards


The third day’s presentations comprised

of TB case definitions, TB treatment and

monitoring, 3ls of TB control, patient

support and DOT. Some of these ses-

sions included visual presentations which

were quite helpful to the participants. The

fourth day covered the basics of drug

resistant tuberculosis (DR-TB) and TB

supply chain management. Finally, on

the last day the Monitoring and Evalua-

tion (M&E) module was covered.

To assess knowledge gain and transfer

participants were given a pre-test to as-

sess their level of knowledge at the be-

ginning of the training and a post-test to

evaluate how much they learnt at the end

of the training. According to results from

both the pre-test and post-test the aver-

age knowledge gained was 36%. Despite

emphasis on how indicators are devel-

oped and exposure to indicators, partici-

pants still performed poorly on the indica-

tors questions. This showed that partici-

pants still need to be trained on M&E.

JUNE

Nompumelelo Ndwandwe, TB/HIV Regional Coordinator facilitating during the workshop.

Participants sitting-in during the proceedings of the workshop.

OTHER FACILITATORS

Dr Arnold Mafukidze, TB/HIV Clinical Advisor

Julius Manjengwa, TB Lab Advisor


USAID ASSIST project and the CDC-

URC lab project in collaboration with the

National Quality Management Programme

seeks to improve the capacity of

healthcare workers to apply Quality Im-

provement (QI) approaches to make es-

sential services better meet the needs of

patients, improve efficiency, reduce the

cost of poor quality, and improve the ca-

pacity of HCWs on QA/QI methodologies.

On the 30 June-04 July 2014 at Esibayeni

Lodge a TOT training was conducted to

establish a group of Quality Assurance

(QA) trainers to support rollout of quality

improvement and develop competencies

and capacities of imparting training to other

health care workers. The training benefit-

ted 13 participants drawn from hospitals,

health centres and the region.

The participants were trained over a 5-day

workshop. The workshop was designed to

have technical presentations, group delib-

erations and plenary sessions. This al-

lowed participants an opportunity to share

experiences, learn new approaches for

knowledge and skill transfer and develop-

ing lesson plans. By the end of the train-

ing the participants were expected to be:

Trained as trainers for field level

training activities.

To develop necessary skills in

organising and conducting QA/QI

training

TRAINING OF TRAINERS (TOT) ON QUALITY ASSURANCE/ QUALITY IMPROVEMENT: Improving Capacity of Healthcare Workers to Apply Quality Improvement


To provide an understanding of the

principles and practices of the

training process.

The National Quality Management Pro-

gramme Manager, Thuli Thomo-Dlamini,

remarked that QI should be central for all

health delivery services within available

resources and against set standards to

improve regional outcomes. She further

emphasized that QA and QI is everybody’s

business and needs to be an integrated

part of all activities in all programs and

services.

JULY

THE NEW REIGNING QRM QUEEN

The first URC-

Swaziland QRM star

has officially handed

over to another qualify-

ing individual.

Congratulations to our

QRM star…

Yvonne Makwabara

SOCIAL Extra...


NEW ADDITIONS TO THE URC FAMILY


SOCIAL CORNER

NAME: Bongile Nzima

DESIGNATION: Finance Manager

EXPERTISE:

NAME: Ntombikayise Nkambule ’Kayise’

DESIGNATION: Human Resource Manager

EXPERTISE:

NAME: Dr Arnold Mafukidze

DESIGNATION: National TB/HIV Clinical Advisor

EXPERTISE:

NAME: Victoria Masuku ‘Vicky’

DESIGNATION: University Research South Africa

(URSA) National URSA Project Coordinator

EXPERTISE:

Human Resource Management, Recruit-

ment, Performance Management, Bene-

fits Administration

Financial Accounting, Financial manage-

ment & Reporting ,Auditing

Public Health specialist, Organizational

Development and Project Management

Clinical management of TB (including MDR-

TB) and HIV in resource-constrained set-

tings



SOCIAL CORNER

… For Laughs

NAME: Tumelo Mampa

DESIGNATION: Lab Quality Advisor

EXPERTISE: Laboratory technologist, Quality Assurance

and microbiology TB

NAME: Sarah Darteh

DESIGNATION: HIV Lab Mentor

EXPERTISE: Masters in Business Admin, Laboratory Technologist, HIV lab Mentor, Malaria Lab Diagnosis Coordinator

NAME: Bathabile Simelane

DESIGNATION: Human Resource Assistant (Volunteer)

EXPERTISE: Development studies; development econom-

ics and policies; research. Data management, Report

writing and Welfare analysis

NAME: Njabuliso Maphanga ’Njabu’

DESIGNATION: Intern (project DGF TB in the mines)

EXPERTISE: Clinical management; psychosocial support;

community care and midwifery


Experience can be defined in a number of ways. The best definitions being it is an observation of facts or events which leave impressions

on one; and knowledge and skill acquired over time and finally. In short we can refer to ‘Experience’ as the best teacher! Taking advantage

of experience to analyse workshops can be beneficial. This process of analysing is known as After Action Review (AAR), this is a brief

meeting that focuses on a single activity. Its purpose is to analyse the difference between planned and actual experience, identify the les-

sons and create an action plan to improve the next time.

LEARNING FROM A TEAM’S OWN EXPERIENCE

Page 12 URC-SWAZILAND MONTHLY NEWSLETTER June-July 2014

KNOWLEDGE NUGGETS

What did we set out to do?

What did we actually do?

Why did it happen? (good or bad)

What can we do next time?

Who are we going to tell?

AAR STRUCTURE

For an AAR to be useful the team must have a clearly stated objective it is trying to achieve. The objective can be an outcome objective or a process objective.

Conducted by a facility team on a regular basis

or after an important event

During a coaching visit

Among the organizing team at the end of a

learning session

Among the trainers at the end of a training ses-

sion

WHEN TO USE AAR?

Openness, not hiding

Leaders and team members on equal footing

Learning, not blame or evaluation – nothing

said at an AAR goes into personnel records

Don’t rush to solutions

Everyone involved takes part

No outsiders should be present

Deal with the significant issues, not trivia

Facilitated – outsider or trained insider

Held consistently, not just when things go

wrong

AFTER ACTION REVIEW GUIDELINES


UPCOMING ACTIVITIES IN AUGUST:

National TB QRM

TB NSP plan

Leadership and Management Training

NCD policy strategy

URC Planning Workshop

MOH Cultural Day

Lab mentoring

URC Orientation

Regional Semi Annual Review Meeting (RESAR) - Hhohho region

University Research CO., LLC (URC) 3rd Floor, North Wing, Building 1

Mbabane Office Park

Sozisa Road

P. O. Box 1404 Mbabane H100, Swaziland

Tel: (+268) 2404 7154/56/69

Fax: (+268) 2404 7199

Website: www.urc-chs.com

OTHER ACTIVITIES IN JUNE - JULY:

EDITORIAL TEAM

Jilly B. Motsa

Janet Ongole

Dr Marianne Calnan

Dr Samson Haumba

URC– SWAZILAND

Who Are We…

University Research CO., LLC (URC) is dedicated to improving the quality of

healthcare, social services and health education worldwide.

Mission

URC’s mission is to provide innovative, evidence– based solutions to

health and social challenges worldwide.

Expertise

In Swaziland, URC expands access to and improves the quality of services

addressing infectious diseases including HIV/AIDS, TB, and improving laborato-

ry quality management system

Approaches

URC focuses on finding ways to deliver proven approaches to health care prob-

lems, applying quality improvement (QI) methods and conducting research and

evaluation to tailor those approaches to various settings. Recognizing imple-

mentation barriers unique to each setting, we train local managers and service

providers to apply QI methods to strengthen health systems, integrate system

elements, and bring improvements to scale. URC also specializes in designing

health messages and materials to educate target audiences about improving

health behaviors.

Men’s Health month

RHMT Training

PSI Cough Officer training on TB management

Wellness Centre Healthcare Screening Report Sharing With Focal Persons

MDR-TB training

IST Quality Improvement

Model Clinics Collaborative Learning & Sharing Sessions

Intensive Case finding PHU Training

SWAMIWA Volunteers train-ing

Pre-service Training for Grad-

uating SANU Nurses

RSSC Feedback Session &

On-site QA/QI Training
http://www.urc-chs.com/../../hiv/aidshttp://www.urc-chs.com/../../tuberculosishttp://www.urc-chs.com/../../health_communication_and_behavior_changehttp://www.urc-chs.com/quality_improvementhttp://www.urc-chs.com/quality_improvementhttp://www.urc-chs.com/research_and_evaluationhttp://www.urc-chs.com/health_systems_strengtheninghttp://www.urc-chs.com/behavior_change_and_communication_2

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