Bukedea Health Centre IV
Ministry of Health Uganda
Bukedea Health Centre (HC) IV is a government health facility in Bukedea district, and serves a s referral point for the lower units. District population is approximatimately 200,000 people and as of March 2011, 452 patients had ever-enrolled in HIV care at the facility with 33 on ART. The problem was poor appointment keeping by the clients enrolled in the HIV clinic, adn this would affect service delivery since they would seek care on dates where they were not supposed to. That way, the facility had trouble identifying the number of patients active in care.
We improved storage of patient files by using empty Plumpy Nut boxes to arrange files according to patients' return dates. However, this did not improve patients' adherence to scheduled appointments. We started using the Ministry of Health (MoH) patient appointment book. However, this was not designed to suit our needs so within the team we agreed to redesign it to capture date of appointment, patients' name, client number on a clinic day and date of next appointment. We also included a column to tell if patients were on ART or pre-ART. Through on-job mentorship, colleagues learnt how to use the book and we all agreed. Even when I am away, colleagues can use the same book to track patients' appointments.
We also introduced and emphasized the use of the MoH appointments card that reminds them about the scheduled appointment which is written on the card. Now all patients have an appointments adherence card. Previously, return dates were written in the patients' book which they could forget easily or leave in another service point.
There was a drastic improvement in clients keeping their appointments and returning on the schedlued dates. This was also highlighted by the patient HIV care cards where we started seeing a trend of patients keeping appointments as opposed to previously when they would show up as they wish.
A cohort of 26 patients that we started following in February 2011 as we started using th appointments book showed that 53.8% kept the exact scheduled appointment in March 2011, and following the same cohort in April showed that 75.8% kept their appointments. This is already showing improvements in appointment keeping by patients in care.
Providing HIV care in Uganda has a wide range of problems, and efforts to solve one problem can help you identify another underlying problem. In Bukedea, our efforts to improve storage of patients' files highlighted another problem where patients do not keep clinic appointments. The gaps observed in adherence to scheduled appointments was addressed by using already existing MoH tools; the appointments books which had to be modified to suit the clinics' needs, and the appointments adherence card. This illustrates the need for flexibility and not getting stuck with generic tools developed by the MoH.