APPLYING QUALITY IMPROVEMENT PRINCIPLES FOR PMTCT OPTION B+: THE BEST PRACTICE OF LUGEYE DISPENSARY 4th National Quality Improvement Forum, NQIF BOT Conference Hall 30th to 31st October, 2014 Salma Nasoro1, Elizabeth Biseku1, Magreth Nadila1, Hobhokela Stephen2 , Jared Mussanga2 ,William Bendela3, Pastory Sekule3, Moses Ringo3, Sarah Gaula3, Bernard Mbwele3 LUGEYE DISPENSARY UNIVERSITY RESEACRH CO,. LLC. (URC) 3. CHRISTIAN SOCIAL SERVICES COMMISION (CSSC)

Background Lugeye Dispensary was established in 1958 with an honour of Chief Sima Sumve for his people. Later on in 1967 Missionaries supported Health Service with three staff houses and two toilets. From 1958-1959, A temporary Dispensary of Lugeye Village was having one rural medical assistance, Arobogast Mchele 1964-167 there was one Medical Attendant, Andrew Mbio 1968-1970 there was one Medical Attendant TBA Fredrick Maga 1970-1973 there was one who was Medical Assistant (MA) from Sithuas Mwalimu   After Arusha declaration in 1974 Lugeye dispensary was over thrown by the government . It was having one medical assistant doing everything for health care delivery.

Background Lugeye dispensary is handling a range of 40 to 50 mothers for reproductive and child health per day. A range of 70 to 80 patients for OPD and an average of 20 patients for inpatients per day. In 2005 when MCH services started PMTCT with single dose Nevirapine, the facility had 2 rooms and 3 health care workers only for handling all services.

PMTCT at Lugeye In 2009 Option B started, The facility presented with 64% of incomplete of adherence of Zidovudine, AZT from the 6th week to the end of Pregnancy 98% of mothers received Lamivudine during labour However due to defaulters in AZT during Pregnancy, 72.5% of mothers received Nevirapine after delivery. In 2013, Option B+ started, with so many Quality worried on retention of mothers and outcome of infants.

Methods Village meetings in distributed responsibilities for 10 sub-villages of Lugeye ward on fundraising required for construction of the modern dispensary with admission wards. The facility was renovated in 2006 for male ward, 2009 female ward and PMTCT and OPD, 2014 paediatric ward, 2014 x-ray room and 9 more staffs recruited through Magu Council strategy, AMREF and community contributions. From 2012 to 2014 a total of 8 new health care workers have been enrolled after setting targets for quality health care delivery by the council. The President of United Republic of Tanzania awarded an ambulance in January 2014.

Methods… In October 2013, February 2014, 2 staffs out of 12 staffs from Lugeye were trained for PMTCT option B+. In February 2014 and May 2014, URC- Assist and CSSC developed quality improvement implementation plan through the use of 18 quality improvement indicators that aimed at testing all pregnant mothers and breast feeding mothers (with their spouses),

The Core QI indicators Proportion of mothers tested each month Proportion of mothers repeated testing each month Proportion of HIV positive mothers enrolled to ART each month Proportion of exposed infants received Nevirapine syrup each month Proportion of exposed infants with DNA PCR Sample taken each month Proportion of exposed infants with DNA PCR Results given to exposed infants each month Proportion of HIV positive infants enrolled to ART each month Proportion of HIV positive Mothers enrolled for care and treatment who have been retained each month

Results Currently the dispensary has 6 Buildings and13 staffs implementing the services for Male ward, Female ward, labor ward, Pediatric ward, Postnatal ward, PMCTC, Outpatient care, Medical record reception, Laboratory, Vaccination room and Dispensing rooms.

A dispensary with Ambulance

Results… From October 2013 to September 2014 the facility found the case for Option B+ in December 2013. Among 430 mothers attended for antenatal care, 399 antenatal mothers were tested (92.7%) and 32 breast feeding mothers who missed HTC during their pregnancy from January 2013 to September 2013 were tested in January 2014 to June 2014.

Results… By August 2014, Cumulatively 30 mothers were on TLE (100%) for OPTION B+ (3 transferred out, 27 are attending at Lugeye). Yearly registered exposed infants were 21 all of them received Nevirapine (100%), all tested for DNA PCR (100%). 19 infants’ Mothers received status of DBS (90.5%), (100%)18 got negative results and 1 sample was rejected and 2 samples were just been sent July. DBS testing kits were available for 6 months only, HIV rapid Tests were available for 10 months of the year. From August 2013 to August 2014, Outcome revealed 16 Babies survived, 2 transferred out, 3 babies died all with negative results

Discussion Community Mobilization motivated many donors to support Health Care Delivery Staff commitment in following QI indicator supported good outcome of care. The availability of infrastructure was a key contributor of success of quality improvement. The dispensary is working on the construction of incinerator , expect to upgrade to health centre.

Conclusion Commitment of district council and the contributions from villages plays great role in the set up of better health care infrastructure, staff mobilization and hence quality improvement.

Acknowledgement “Diwani” Destery Kiswaga from Magu District Council for his influence in the community The people of Lugeye for their contribution and commitments We acknowledge the QI support of Dr Bernard Mbwele from CSSC for showing the way Dr Hobhokela Stephen from URC Assist Project for guidance of QI indicators Monitoring and Evaluation Team of CSSC led by Sarah Gaula CHMT members of Magu District (DMO, DACC, DRCHCo) CSSC and their USG funding support

Wabheja Sana Ahsante Sana Thank you very Much Ndagha Fijho