1. Quality Improvement in a Tuberculosis Clinic in Chimbote, Peru Guillermo E. Frias, MD, MPH Quality Healthcare Project APHA 139th Annual Meeting, Washington DC November 1, 2011

2. Disclosure “There are no relationships to disclose”

3. Situation Analysis Yugoslavia Health Center 42 TB cases, 3 MDR-TB cases, 6 children TB cases Understaffing No personnel responsible for TB prevention Low numbers in diagnosis and treatment of TB cases. Cases of defaulters to treatment Peru 34,000 TB cases, 60% are concentrated in Lima Ancash Region 780 TB cases, concentrated in Chimbote area Health system is severely deteriorated

4. Social Dialogue Gaps identification, standards definition Implementing best practices at the facility at the facility Assessing progress Recognition Performance Improvement Methodology -PIM

5. Performance improvement guidelines

6. Gap identification of best practices for TB prevention Yugoslavia Health Center Gaps identified -Low enrollment of TB suspect cases -Incomplete records registration -Understaffing and no one responsible for TB cases Main causes -Lack of knowledge of TB national norms for TB prevention -Lack of motivation of health personnel -Deficiencies in managerial resources due to lack of technical assistance from health network -Lack of versatile human resources

7. Implementing best practices for TB prevention: enrollment of TB suspects Action plan in the facility New unit for sample collection outside the facility, Yugoslavia Health Center, 2010 Health provider showing mask used during training workshop on biosafety procedures, 2010

8. Implementing best practices Improvement plan development, 2010 Map of TB cases used for active enrollment of suspected cases in the community, 2010

9. Results

10. Recognition

11. Lessons learned TB clinic performance depends on infrastructure, equipment, supplies, staff and processes, etc. Referring to standardized best practices facilitates positive change Change must be measurable standards defined and with indicators Importance of recognition The performance improvement methodology is easy to use and quickly appropriated by primary health care workers

12. Thank you www.calidadensalud.pe Dr. Oscar Cordón, Chief of Party: ocordon@calidadensalud.pe ocordon@calidadensalud.pe Dr. Guillermo Frías, Regional Operations Manager: gfrias@calidadensalud.pe