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Ethiopia DSD updateZerihun Hika, MD,MPH
HIV Program Advisor, MOHDecember 2020
The CQUIN Project
• Where are we now? • CQUIN Dashboard Results• DART Model Mix
• How did we get here? • Update on CQUIN Action Plan• Program adaptations made in response to COVID19• Successes and Challenges
• 2021 goals and targets
Outline
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
Ethiopia’s CQUIN Dashboard:10 of 13 Domains are in the “Green Zone”
The CQUIN Project
3 Domains Improved:• Policies• Diversity • Training
Change in Dashboard Scores
1 Domain Worsened:• M&E
4th Annual Meeting
2019 2020
The CQUIN Project
DART Model Mix: All People on ART
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
58%
41%
0%1%
Conventional Model
Appointment Spacing Model
Fast Track
Community ART Groups (HEP-CAG and PCAD)
The CQUIN Project
DART Model Mix: People Eligible for Less-Intensive Models (“stable patients”)
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
Outline
• Where are we now? • CQUIN Dashboard Results• DART Model Mix
• How did we get here? • Update on CQUIN Action Plan• Program adaptations made in response to COVID19• Successes and Challenges
• 2021 goals and targets
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
• Activities that have been successfully completed include:• Diversified DART models
• Integration of ASM data elements into national District Health Information
System (DHIS 2) reporting system
• Improved patient coverage
• Developed DSD quality standard tool
Update on CQUIN Action Plan from 11/2019
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
Update on CQUIN Action Plan…
• South-to-South visit • To Zimbabwe to learn and observeCommunity ART Refill Groups andfast track implementation
• Hosted team from Liberia andUganda for experience sharing onASM
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
Activity that is still underway is:
• National appointment spacing model (ASM) evaluation was planned
however, postponed due to financial shortage
Update on CQUIN Action Plan from 11/2019
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
• Developed interim guidance in collaboration with partners
• DSD strengthening well addressed in the guidance
• Provided orientation virtually and cascaded to all regions
• Weekly follow up of service continuity and close monitoring of
supply chain availability
• Tracking lost to follow up and missed appointments
Key policy and practice adaptations made in response to COVID-19
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
Key policy and practice adaptations…
12
• Strengthened DSD models, Multi Month Dispensing:
• Family based refill
• Flexible service delivery model and client centered services
• Hand hygiene, use of PPE, physical distancing, triaging of RoC and
providers with flu like symptoms.
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
M&E adaptations made in response to COVID-19 to enhance data reporting
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
191,735
178,716
91,147
6+ months
3-5 months
<3 months
0 50,000 100,000 150,000 200,000
Mon
ths o
f Pre
scrip
tion
Disp
ense
d
Number of ART Clients Receiving MMD
Multi-Month Dispensing (MMD) of Antiretroviral Drugs by Number of ART Clients, June 2020
The CQUIN Project
• DSD scale up plan• Improved dashboard domain results
• Training• Policy• Diversity of models
• Improvement of DART mix models• Community based ART Refill model (HEP_CAG, PCAG), • AHD, Adolescent DSD, KP friendly service
• MMD experience in the context of COVID 19• Close follow up of service continuity amid COVID 19
Successes
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
• ASM evaluation needs to be conducted as soon as possible• Supplies for AHD (CD4, CrAg, fluconazole)- needs to be
secured• Incompleteness of reports- we are using parallel system for
data collection for the new models
Challenges (other than COVID-19)
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
Outline
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
• Where are we now? • CQUIN Dashboard Results• DART Model Mix
• How did we get here? • Update on CQUIN Action Plan• Program adaptations made in response to COVID19• Successes and Challenges
• 2021 goals and targets
The CQUIN Project
By CQUIN’s 5th annual meeting (end-2021):• Increase the percentage of stable people in less-intensive models to 80% • Diversify model mix
• Add new models: KP DSD model• Expand existing models: Community based ART Refill model (HEP_CAG, PCAD), AHD,
Adolescent DSD model
• Integrate TB/HIV services into less-intensive models • Plan for ASM impact assessment• Conduct facility based quality standard assessment
2021 Goals and Targets
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
The CQUIN Project
• CQUIN Project team• Bill & Melinda Gates Foundation• ICAP-NY/Ethiopia team• National DSD TWG members• PEPFAR• CDC Ethiopia• USAID Ethiopia• Project Hope Ethiopia• CSOs• CQUIN network countries• GF
Acknowledgements
The CQUIN Project 4th Annual Meeting | December 7-10, 2020
Thank you
