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Infectious Disease Capacity-Building Project Releases Findings in New Report
Accordia Global Health Foundation published a new report today that shares findings and lessons learned from the Integrated Infectious Disease Capacity Building Evaluation (IDCAP) Project. Through the project, URC’s non-profit affiliate, the Center for Human Services (CHS), helped improve outpatient triage—the sorting of patients according to the urgency of their need for care—in 36 rural Ugandan clinics.
CHS’s role was to provide on-site support services (OSS) to clinic staff: The OSS was a combination of training, mentoring, coaching, and other services that health experts provided to health workers at the workers' clinic, as opposed to an off-site location. The OSS approach prevents workers from having to leave their workplace to acquire the skills and knowledge needed to do their jobs more effectively.
IDCAP, a three-year project funded by the Bill & Melinda Gates Foundation, evaluated a cost-effective method, including training and on-site support, to build capacity among mid-level health care practitioners (e.g., nurses and clinical officers) in sub-Saharan Africa for the treatment and prevention of infectious diseases (see box).
CHS served as sub-contractor to Accordia and, to manage the project, partnered with the Ugandan Ministry of Health, Infectious Disease Institute at Makerere University, International Training and Education Center for Health at the University of Washington, the University of Manitoba, and the University of Winnipeg.
CHS led the project’s mobile teams, which provided OSS to the practitioners through group training, individual coaching, and continuous quality improvement (CQI) activities. CQI is an approach to quality management that gathers, assesses, and uses data on an ongoing basis to improve performance and develop more efficient systems of care.
The mobile teams—comprising a CQI expert/medical officer, clinical officer, laboratory technician, and district nurse—were trained in infectious disease management, the use of clinical tools, mentoring, coaching, team building, communication, and conflict resolution. The teams visited the clinics monthly to provide on-site support in key areas, such as emergency triage, assessment, and treatment (ETAT); fever, malaria, and TB case management; and comprehensive HIV care.
Building Practitioner Capacity and Improving Clinic Performance
After completing a baseline assessment, IDCAP found significant deficiencies in infectious disease care processes and the need for capacity building among non-physician practitioners. Consequently, the program developed an integrated package of capacity-building activities with two main components: 1) a core curriculum of infectious disease training for clinical and nursing officers and 2) OSS for clinic-level multidisciplinary teams of medical and clinical officers, nurses, midwives, laboratory technicians, and record keepers.
Over a nine-month period, IDCAP conducted a randomized controlled trial at 36 rural clinics throughout Uganda to measure the effect of training and OSS on practitioner competence, facility performance, and patient health outcomes. Widely accepted as an objective scientific methodology yielding unbiased results, a randomized controlled trial is a quantitative study in which investigators randomly select participants (health facilities, in this case) to receive one of several interventions, or changes to a current system or process, and then compare the outcomes of these changes on participants. For this study, investigators randomly selected 18 sites, designated as Phase A, to receive both infectious disease training and OSS. The remaining 18 sites, Phase B, received training alone. (IDCAP provided OSS at Phase B sites after the study ended.)
As the figure shows, Phase A sites experienced a statistically significant increase in the number of outpatients triaged: from approximately 45% in April 2010 to almost 100% in December 2010, more than doubling the percentage of patients triaged. The percentage at Phase B (training-alone) sites rose about 20%, suggesting that OSS combined with training—as opposed to training alone—can improve facility performance and infectious disease care. IDCAP’s investigators recommend efforts to validate these results in hopes of scaling up OSS at health facilities throughout the country.
Note: Clinics in both phases received infectious disease training; only Phase A clinics received OSS for ETAT.
In addition to improving outpatient triage, IDCAP:
- Established data surveillance systems in the 36 clinics to collect routine clinical and laboratory data;
- Integrated CQI into the OSS model;
- Trained over 700 mid-level practitioners in CQI;
- Linked CQI to the Ministry of Health institutionalization process to ensure sustainability;
- Developed several training tools, including:
- An Integrated Management of Infectious Diseases core course curriculum,
- Booster course curricula,
- Multidisciplinary training course curricula,
- Distance learning tools,
- Clinical decision guides,
- A revised outpatient record form,
- ETAT guidelines and monitoring tools,
- The IDCAP Mobile Team Data Collection Tool,
- The IDCAP Mobile Team Check List,
- An action plan template,
- A documentation journal for CQI teams, and
- A synthesis form for summarizing improvement changes and results.
June 27, 2013