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Swaziland
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Reducing the effects of HIV/AIDS in rural communities through a holistic approach by volunteer caregivers in Shiselweni, Southern Swaziland
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Improvement Report
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Creating an Enabling Environment for Task Shifting in HIV and AIDS Services: Recommendations Based on Two African Country Case Studies
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Community Resource
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Facilitating Active Lab Sample Transport (FAST) System Using Public Mini-Buses – Report of a Pilot Program in Swaziland
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Improvement Report
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Implementing a successful quality improvement program in a TB diagnostic facility in semi-rural Swaziland
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Publications
This short report describes the efforts of the Piggs Peak Hospital in the Hhohho Region of Swaziland to apply continuous quality improvement approaches to TB-HIV care.
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Synthesis of Findings and Learning from the Field Testing of Learning System Tools: The Standard Evaluation System (SES) Team Documentation Journal, Team Synthesis Form, and Excel Results Databases
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Publications
In 2008, the USAID Health Care Improvement Project (HCI) took on the challenge of improving the learning system for health care improvement. This learning system includes the processes of harvesting, analyzing, and synthesizing knowledge about what teams do to improve health care and the process of sharing what they learn with other QI teams. Using experience to date and some innovations, HCI developed a set of four tools—collectively known as the “Standard Evaluation System” (SES) tools—for teams and their coaches to use to facilitate these knowledge management processes. The SES tools include a QI team-level Journal, a QI team-level Synthesis Form, and two databases for results indicator data—one for QI teams and the other for the collaborative level. These tools were created to help support the collaborative learning system by which teams examine which of their changes were most effective and sharing this learning with other teams in the collaborative. This report summarizes the results of testing these SES tools to strengthen documentation, analysis, and sharing of QI team efforts to improve care through testing of changes.
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PEPFAR | Care that Counts: Improving the Quality of Programs for Orphans and Vulnerable Children
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Publications
Lessons Lessons learned from OVC programs have revealed the need to improve service quality and to strengthen harmonization across partners around the questions: How can our programs make a measurable difference in children’s well-being? What are the essential actions that we all agree need to be part of a service to best to mitigate the impact of HIV/AIDS on children and families, in the pursuit of efficiency, effectiveness, equity, reach, and scale and sustainability? In response to the observed need to improve the quality of services provided to orphans and vulnerable children, in 2007, PEPFAR, through the United States Agency for International Development (USAID), sought to create a regional initiative to support countries and implementing partners in improving the quality of OVC programming. With support from the USAID Health Care Improvement Project (HCI), a regional OVC quality improvement initiative was organized. The initiative, which has come to be known as Care that Counts, has engaged national stakeholders, program implementers, and donor agencies throughout sub-Saharan Africa in improving the quality of OVC programming.
This short report describes the efforts of the Care that Counts Initiative to support to implementers at the country level to:
1) Build constituencies and commitment for quality in OVC programming,
2) Develop OVC service standards through consensus processes involving key stakeholders, including children and their families,
3) Undertake quality improvement activities at the point of service delivery with community-based volunteers and organizations, and
4) Gather evidence that standards and other quality improvement approaches have a measurable impact. -
Intensified TB case finding in Swaziland
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Publications
The increasing number of cases of TB associated with HIV infection in Swaziland has greatly increased the demands on TB and HIV treatment programs. Swaziland has an estimated TB incidence of 1,155 cases per 100,000 population per year (nearly a six-fold increase compared to a 1990 level of 267), while the incidence among the infectious sputum smear positive cases tripled within the same period. To better inform the NTP on magnitude and risk factors, Women Together, SWANEPHA and HCI carried out intensified case finding that targeted PLWHIV and their households. The setting was eVembili, a rural constituency. An HIV-positive member of the Women Together PLWHIV group was the index case for whom household members were enrolled. A standard checklist was used to record symptoms and their duration, risk factors, and results from sputum smear and x-ray examinations. Participants were classified as either TB suspect or case or Not TB. Results were confidentially communicated to each participant, who was given appropriate medical advice, treatment or referral. Ethical clearance obtained from the national Scientific and Ethics Review Board, participation was voluntary, and informed consent was sought. Intensified case-finding helps identify TB suspects and risk factors for TB common among PLWHIV and household members in local settings and inform strategies for community TB screening, health education and household infection control. Of the 111 study subjects, 34 (30.6%) were HIV-positive, 20 (18%) were HIV-negative, and 57(51.4%) had unknown HIV status. Sputum samples were requested on all 111 study subjects; however, only 69 cases (62.1%) provided sputum samples. Of the 69 samples, one was saliva but still tested AFB-positive, one sample was AFB-positive, and 67 samples were AFB-negative. All 111 subjects were interviewed with the checklist on common TB symptoms and risk factors. The most common TB symptom reported by study participants was noticeable weight loss (reported by 37.4% of subjects), followed by persistent cough (over two weeks) (reported by 36.9%), night sweats (reported by 36.9%), malaise (30.6%), fever (27.0%) and loss of appetite (20.7%). Recommendations: • Active case-finding and household contact tracing should be implemented as a package of care for HIV-positives • Partnerships with local HIV support groups in intensified case-finding is an effective strategy to identify TB suspects and TB cases in communities with high TB/HIV co-infection.
