Using data for more responsive programme improvement CQI Webinar 09.28.2016... · Overview...
Transcript of Using data for more responsive programme improvement CQI Webinar 09.28.2016... · Overview...
Using data for more responsive programme improvement
September 28, 2016
Copyright The Water Institute at UNC 2016
Overview
• Introductions
• World Vision and UNC Partnership
• Overview of Continuous Quality Improvement (CQI)
• WaSH CQI experience in W. Africa
• Ghana and Niger teams present CQI Experiences
• CQI in W. Africa: Results
• CQI in Health Care Facilities
• Next steps for CQI for WV
The Water Institute at UNC
Introductions: Advisory and Management Team
Pete Kolsky
M&E AdvisorRohit Ramaswamy
CQI AdvisorKaida Liang
Project Manager
Jamie Bartram
Water Institute Director
The Water Institute at UNC
Introductions: MEL Research Team (Selected Members)
Dr. Mike Fisher
Postdoctoral Researcher
Emily Madsen
Field Researcher
Allison Fechter
Research Associate
Ryan Cronk
Research
Assistant
The Water Institute at UNC
• Develop solutions to improve WaSH for all.
• Conduct work that is relevant and practical by linking advanced methods with policy and practice.
• The MEL Focus Area uses high-quality monitoring and analysis methods to measure and improve WaSH programs.
• Annual Water & Health Conference at UNC!
What is CQI?
CQI is a systematic way of using data to solve complex problems without intuitive solutions
Problem
Complex?NoYes
CQI Fix it
A formal approach to the analysis of performance and systematic efforts to improve it
Institute for Healthcare Improvement
What is CQI?
• Get a good understanding of the system
• Understand where it is failing - Identify what is wrong
• Understand the root causes for failure
• Generate and test solutions
• Implement and monitor
What is CQI?
15.0%9.4%
23.6%
52.0%
0%
10%
20%
30%
40%
50%
60%
Conformity Low Intermediate High
Pro
po
rtio
n o
f H
ou
seh
old
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Microbial Risk
Safety of Water Consumed in Households: Northern Ghana
• Some complex problems in WaSH
Sustaining water source functionality
Reducing the proportion of dry wells drilled
Improving water quality
WaSH CQI: Define the Problem
• Create CQI Team
• Kickoff Meeting
• Identify Priorities
• Create Charter
• Data Collection Plan
• Communication Plan
WaSH CQI: Define the Problem
Plan Improvement Project
• 4 districts in N Region
• 230 Communities
• 926 water sources
• 527 households
• Water quality testing
• Data on source and household characteristics
WaSH CQI: Measure
Collect Data
Achievements
• Form CQI team and develop initial project charter (2014)
• Assess water and sanitation situation in 230 communities in 4 districts in Northern Ghana
• Analyze data and develop improvement package
– Refresher training and tools for WSMTs
– Safe storage containers for households
• Deliver improvement package to 50% of communities in all 4 districts (selected at random)
• Follow-up monitoring to assess impact
• Deliver remaining tools to intervention communities
Challenges
• Delay in procurement of tools
• Logistical difficulties implementing solutions in over 100 intervention communities
– Distance, weather, road conditions
• High turnover of CQI team members in Northern Ghana (change in PM, CQI project coordinator, many CQI team members, GIS officer, etc.)
Lessons Learned
• WSMT Performance and Borehole Functionality Some WSMT’s have added members after receiving the
WSMT training
Many communities conducted borehole maintenance without external help
Some communities have started revenue mobilization
• Many HHs using Safe Water Storage Containers for primary drinking water More children than adults drink water from SWSCs
Some broken containers observed, most knocked down accidently by a person or an animal
Some HHs still serve drinking water from unsafe containers to children below age 5
Continuous Quality Improvement (CQI) implementation
Niger experience
By Hamissou Maliki NIWASH Assistant Manager
Achievements
• Producing CQI Action Plan
– Problem statement, charter, data collection plan, etc.
• Hiring and training enumerators
• Ethical approval for surveys
– National and local
• Logistics and organization
• Data collection and quality control
– Group supervisor, regular meetings and feedback
Lessons Learned
• Competency building for WaSH staff (M&E and technical skills)– Ensure data quality
– Identify areas of concern
– Additional training as needed
• Regular meetings of CQI team
– Share challenges
– Identify practical solutions
• Full time enumerators
– Quality and continuity of data collection
• Language barriers
• Rainy season delayed data collection
Way Forward
• Complete data collection
• Analyze the data• Identify solutions• Implement
solutions • Standardize
solutions
Factors affecting water quality:
• Source Type
• Safe storage
• Latrine
• Soap present
• Proper handwashing
WaSH CQI: Analyze, Identify
Household Water Quality
Source Type
Safe Storage
Soap PresentHandwashing
Latrine Present
Safe storage containers distributed
• Tap and lid to prevent contamination
• Problems identified:– Users removed lid to dip with
cups
– Containers knocked over by children, goats
– Containers locked inside to prevent breakage- not used
WaSH CQI: Implement Solutions, V 1.0
WaSH CQI: Implement Solutions, V 3.0
Container Improvements:
– Small opening prevents dipping
– Can still pour from head or shoulder
– Metal stand more stable
V 1.0 V 3.0Water in Container 79% 89%Signs of recent use 77% 89%Container cracked or broken 21% 5%Water safely extracted 89% 95%
WaSH CQI: Sustain and Scale
• V 4.0?
• Adapting to local context
• Using data to improve Implementation
– When you hear “Everyone knows we just need to do X”
– Don’t forget to ask “Is it goat-proof?”
• 21 beds
• Up to 50 babies at once
• Bed sharing occurred on 86% of days
• Hand hygiene training; Visual reminders posted
• Weekly reinforcement during staff meetings
• Additional hand towels supplied to NICU
67%53%
74%
89%92% 89%98%
88%
0%
20%
40%
60%
80%
100%
120%
TotalObservations
DiaperChange
Feeding Examination
% A
dh
ere
nce
NICU Activities
PRE %Adh
POST %Adh
Handwashing increased from 67% to 92%
NICU hand hygiene: Ridge hospital Ghana
•Dedicated maternity theater
•“Banding” for high- priority cases
•Training medical officers to perform surgery
• Improved monitoring of post-surgery recovery
• High wait times for surgery
• No differentiation between high and low priority cases
• Limited availability of staff surgeons
05
101520253035
10
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34
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45
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0
67
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89
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Post Surgery Recovery Times in Minutes
BEFORE Post Surgery Recovery
Time
0
10
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40
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27
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53
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66
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79
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92
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Fre
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Post Surgery Recovery Times in Minutes
AFTER Post Surgery Recovery
Times
Surgery Wait Times: Ridge hospital Ghana
•Hand Hygiene interventions in maternity ward
•Weekly scrubbing of maternity wards
•Antibiotic eye ointment given to new mothers
•Reliable ward rounds, on-call medical officer
• High rates of maternal infections after childbirth
• Frequent eye infections in newborns
• High rate of breastfeeding complications
Improving Neonatal Outcomes: Ruiru Sub-county hospital Kenya
17%24%
49%
33%
0%
12% 15%
0%0%
10%
20%
30%
40%
50%
60%
NewbornInfections
(Except eyes)
Newborn EyeInfections
MaternalInfection
BreastfeedingComplications
Neonatal and Maternal Complications
PRE POST
Next Steps for World Vision CQI
• CQI projects launched in Ghana, Niger, Mali
• CQI to expand to one new region by 2017
• Additional new regions planned
• Hub and spoke model
Regional Training
Hub
UNC WIFacilitator
Role
Spoke Country
Spoke Country
Spoke Country
Online training
Resources