THE QUALITY OF INFECTION PREVENTION AND CONTROL PRACTICES IN TANZANIA: A comparison of performances between assessments conducted in Sept 2011 and May 2012 in 36 hospitals Henock Ngonyani, MD., MPH Asst Director – Health Services Inspectorate & Quality Assurance Section MoHSW - TZ

PRESENTATION OUTLINE Background Objectives Methodology Results Conclusion 2

BACKGROUND MoHSW through Health Services Inspectorate and Quality Assurance Section (HIS/QAS) which is under the Directorate of Health Quality Assurance (DHQA), has engaged in activities to improve the quality of infection prevention and control (IPC) since 2004 Under this initiative, the MoHSW conducts supportive supervisory visits biannually, as part of routine monitoring and evaluation of its programmatic activities’ implementation During these visits, which are carried out in collaboration with technical partners (currently, Jhpiego), facilities’ HQITs & HMTs get an opportunity to be mentored and coached on how to comply with the National IPC Standards 3

APPROACH USED: - Standards Based Management & Recognition Approach (SBM-R) 4 What is SBM-R?  Practical management approach for strengthening performance and quality of health services  Based on use of operational, observable performance standards for on-site assessment  Must be tied to reward or incentive program The Four Steps Of SBM-R Process

The National IPC Standards 5 There are 60 standards Assessment areas include  Health Care Waste Management [Segregation, Collection, Storage, Transport and Final Disposal]  Instrument & Linen Processing [Decontamination, Cleaning, Sterilization]  Transmission Based and Standard Precautions  Availability of IPC - related supplies [PPE, Disinfectants and Antiseptics]  Safe procedures for IM, IV and Catheter insertion and maintenance, OR, etc  Availability and Accessibility of Guidelines and SOPs  Management support to smooth implementation of IPC practices [Admin/HMT, QITs and WITs commitment]

QI Implementation Cycle 6 Model Adapted from the International Society for Performance Improvement Desired performance Actual performance Gap Cause analysis Intervention identification & implementation

Intervention Identification & Selection Capability (Know how to do) Opportunity (Be enabled to do) Motivation (Want to do) Knowledge/skills and information Resources, tools, capacity Inner drive, incentives TRAINING INFORMATION MANAGEMENT SYSTEMS RESOURCES REWARDS DISINCENTIVES GAP INTERVENTION PERFORMANCE FACTORS

To assess health workers’ performance in implementing and complying with the set National IPC standards To compare the current vs. September 2011 IPC assessment results, and To identify persistent and newly emerging performance gaps. OBJECTIVES

METHODOLOGY A standardized checklist (National IPC Standards) was used The assessment were unannounced, and all took place within two weeks Prior to exercise, the “national assessors” were oriented on; ◦ Principles of conducting an objective assessment ◦ Ethics (mainly respect to providers and patients / clients) Feedback meetings to discuss strengths and areas of improvements were held with HMTs, QITs, heads of departments and units, and where applicable with RHMTs and CHMTs Zonal and facility-specific reports generated by the MoHSW and shared with C/RHMTs and HMTs

RESULTS In May 2012, a total of 36 hospitals in the Tanzania Mainland; were assessed, and these included ◦ 4 Consultant, ◦ 3 Special, ◦ 23 Regional, ◦ and 6 at District level. Compared to September 2011 data, most facilities have shown improvements Presented on the graphs are the scores for May 2012, and the changes in scores compared to the September 2011 assessment

Top performers; =KCMC & MOI Average score; -Sept 2011 = 34% - May 2012 = 46%

- Scores for most of the facilities have increased remarkably -Performances for three hospitals have dropped - No improvements registered in one hospital

Major strengths; Staff awareness on IPC, Good injection safety practices, Excellent laboratory infrastructure favouring compliance with national IPC standards, Some facilities have incorporated IPC related supplies in hospital budgets Areas for improvement; Compliance with standard and transmission based precautions, particularly hand hygiene practices SOPs for various procedures and practices, Instrument processing practices (particularly CSSD infrastructure and planned preventive plan for equi Healthcare waste management

Using performance standards for assessing the quality of services is a good strategy to continuous quality improvement In order to meet the minimum required standards, key actors must address IPC gaps related to not only IPC knowledge, and attitudes, but also human and material resources, strengthening management systems, and staff motivation. It is high time implementing partners working in other technical areas integrate IPC into their programs, by ensuring that all the sites that they support comply with the standards CONCLUSIONS

Other Authors Albert Komba Joseph Hokororo Koku Kazaura Eliudi Eliakimu Honest Anicetus Steven Chombo Natalie Hendler Health Facility Level Management QIT members Staff THANK YOU Central Level  MoHSW support team and national trainers/assessors Donors  CDC