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KwaZulu Natal Province

URC Annual Meeting 13-17 December 2010

Provincial Coordinators: Mrs. P Harrison Mrs. M Ngema Mrs. V Mbatha

USAID HEALTH CARE IMPROVEMENT PROJECT

HCI Facilities

District Facilities

Uthungulu 31 health care facilities

Uthungulu Amakhumbuza Home based care organization

USAID HEALTH CARE IMPROVEMENT PROJECT

Level support provided

DOH Person Responsible Reporting Timeline/ Frequency

Provincial level None at present

District

Level

Mr. M. Zungu Monthly

Sub-district

Level

Ms S. Mavundla

Mrs G. Shange

Mrs C.B.Makhoba

Mrs B. Mthabela

Mrs R.N. Ndabandaba

Mrs N. Shange

Mrs E.T. Sithole

Mr V. Zikhali

Consulting quarterly

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Activities

• Health Systems Strengthening• Provide on going on site mentoring and coaching.

• Training• Provide QA/QI training to all supported facilities in all

HIV and AIDS programme.

• Data management• Capacitate staff in Data analysis and management

• Monitoring• 70% of all DOH facilities in district supported by HCI,

therefore we utilize the district targets to assess progress.

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Results: PMTCT services: FY10

PMTCT Achieved District Target

% Facilities providing dual therapy 97% 100%

Exposed babies PCR at six weeks 2 563 - (51%) 66%

Nevirapine uptake amongst exposed babies

95% 99%

Nevirapine uptake amongst HIV+ ante natals

91% 90%

% Hospitals with monthly peri-natal mortality meetings

N/A 100%

% Ante natals receiving AZT 74% 92%

70% facilities have measures against district targets

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Results – TB services, FY10:

TBHIV Achieved District Target

% PTB diagnosed with smear culture 93% 85%

% Conversion PTB 70% 75%

%PTB Cure rate 66% 81%

% PTB Treatment success rate 70% 83%

% Defaulter rate 16% 6.5%

# PTB cases reported 3404 14 500

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Results: Quality Assurance, FY10

Quality Assurance Achieved District Target

% PHC Clinics implementing Quality Standards

59% 50%

% Hospitals implementing Quality Standards

88% 100%

USAID HEALTH CARE IMPROVEMENT PROJECT

HCT services in Kwa-Zulu Natal, FY09-10

Data for 31 facilities

0

5000

10000

15000

20000

25000

num

bers

0

10

20

30

40

50

60

70

80

90

100

Per

cent

age

(%)

# Pre test counseled 8149 7840 7040 12392 11560 9899 19078 23301

# Tested 7104 7148 6413 11402 10962 9698 18520 22222

# Tested + 2737 2551 2203 3861 3535 3104 4057 4466

# Screened for TB 3374 2677 3597 4178

# CD4 done 2711 2509 2180 5039 3959 2782 3613 4243

HCT uptake 87 91 91 92 95 98 97 95

Screened for TB 95 86 89 94

Positivity rate 31 36 34 32 32 32 33 10

Oct - Dec 08 Jan - Mch 09 Apr - Jun 09 Jul - Sept 09 Oct - Dec 09 Jan - Mch 10 Apr - Jun 10 Jul - Sept 10

New Facilities added

HCT Campaign

USAID HEALTH CARE IMPROVEMENT PROJECT

HCT services: Performance vs. Targets, FY10

0

10000

20000

30000

40000

50000

60000

70000

To

tal (

n)

Target 6600 1800 1800

Actual 61241 15121 10452 14541

Clients tested HIV Clients tested HIV

+

Newly HIV + clients screened for TB

symptoms*

Newly HIV + clients provided with CD4

test*

USAID HEALTH CARE IMPROVEMENT PROJECT

PMTCT: ANC tested for HIV, FY10

Data for 31 facilities

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1st Ante natal vsits 3861 3809 3318 3649 3348 3805 3372 3552

# Tested 3084 2656 2063 3499 3303 3523 3285 3408

# Tested + 917 822 648 1039 1021 1184 1204 851

# Pregnant women receivedAZT

1097 2057 1541 1192 734 761 714 910

Oct - Dec 08

Jan - Mch 09

Apr - Jun 09

Jul - Sept 09

Oct - Dec 09

Jan - Mch 10

Apr - Jun 10

Jul - Sept 10

USAID HEALTH CARE IMPROVEMENT PROJECT

PMTCT: Performance vs. Targets, FY10Data for 31 Facilities

0

2000

4000

6000

8000

10000

12000

14000

To

tal (n

)

Target 7200 2400 105 1800 1050

Actual 13519 2271 103 6217 2598

ANC HIV 1st test

ANC given AZTANC given

food/nutritional Babies given

NVPBabies PCR

tested

USAID HEALTH CARE IMPROVEMENT PROJECT

PMTCT: Transmission rate at six weeks, FY 08-10

Data for 31 facilities

0

100

200

300

400

500

600

700

800

900

1000

# Babies PCR tested at 6/52 698 692 580 891 786 728 913 922

# Babies PCR positive at 6/52 160 34 8 49 35 37 66 26

Oct - Dec 08

Jan - Mch 09

Apr - Jun 09

Jul - Sept 09

Oct - Dec 09

Jan - Mch 10

Apr - Jun 10

Jul - Sept 10

Transmission rate: 23% 4.9% 1.4% 5.5% 4.5% 5% 7.2% 2.8%

Proportion of HIV-exposed babies tested: 51% 46% 42% 54% 54% 50% 44% 59%

USAID HEALTH CARE IMPROVEMENT PROJECT

PMTCT: Compliance with guidelines, FY 09/10

0

10

20

30

40

50

60

70

80

90

100

Per

cen

tag

e (%

)

% Compliance with screening forSTIs

97 98 97 97

% Compliance with screening forTB

51 86 81 85

% Compliance with clinical stagingof HIV+ pregnant women

50 81 79 81

% Compliance with performingCD4 count (HIV+) pregnant women

89 95 94 95

2009 Jan-Mar 10 Apr - Jun 10 Jul - Sept

220 records audited per quarter. Data for 10 facilities performing deliveries

USAID HEALTH CARE IMPROVEMENT PROJECT

HIV/TB: TB patients offered HCT, FY 2008/10

Data for 31 facilities

0

500

1000

1500

2000

2500

3000

3500

4000

4500

nu

mb

ers

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nta

ge

# new TB clients registered 4023 4098 2430 2715 3733 3001 2761 2972

# TB clients tested for HIV 1468 1430 1722 1775 2184 1729 1561 1730

# TB clients tested HIV+ 923 854 1343 1072 1579 1120 1054 968

#CD4 done 0 897 979 903

# HIV/TB clients started Cotrim 887 926 1302 1292 1489 1169 1216 1132

# HIVTB started on ART 199 247 218

#HIVTB already on ART 422 414 400 393

Testing rate 36 35 71 65 59 58 57 58

Positive rate 63 60 78 60 72 65 61 56

% TB already on ART 11 14 14 13

Oct - Dec 08

Jan - Mch 09

Apr - Jun 09

Jul -Sept 09

Oct - Dec 09

Jan - Mch 10

Apr - Jun 10

Jul - Sept 10

USAID HEALTH CARE IMPROVEMENT PROJECT

HIV/TB: HIV clients screened for TB, FY09/10

Data for 31 facilities

0

1000

2000

3000

4000

5000

6000

nu

mb

ers

# Hiv + clients 3196 3907 4739 5373

# Screened for TB 3254 3549 4112 5177

# Clinical work up 2900 2843 3265 4719

# TB positive 9 1001 728 1133

# Started on treatment 1433 1073 708 1133

Oct - Dec 09 Jan - Mch 10 Apr - Jun 10 Jul - Sept 10

%HIV+ clients screened for TB: 102% 91% 86% 96%%HIVTB clients started on TB treatment: >100% 108% 97% 100%

USAID HEALTH CARE IMPROVEMENT PROJECT

HIV/TB: Performance vs. Targets, FY10

Data for 31 facilities

0

10000

20000

30000

40000

50000

60000

70000

80000

To

tal (

n)

Target 12000 60 600 60 600 210 60

Actual 72456 1237 11781 75026 12467 5965 3517

HIV + pts received PRE-

ART care

HIV + pts started on

Isoniazid/INH

HIV + pts receiving

cotrimoxazole

HIV + pts who received

therapeutic or

New registered TB

patients

TB pts with HIV test result

recorded in

TB/HIV + pts started on

cotrimoxazole

USAID HEALTH CARE IMPROVEMENT PROJECT

ARV services: HIV + patients on ART, FY10

(9 facilities of which 4 were dropped at the end of last quarter)

0

2000

4000

6000

8000

10000

Tota

l (n)

Actual 4102 9313

HIV +pts newly started on ART

HIV +pts receiving ART (Current)

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Challenges:

• District Management– Need to strengthen ties with the district

• Human Resource– Lack of skilled personnel– Staff rotation and shortage

• Data Management– Poor recording and reporting

• Infrastructure– Poor infrastructure

• Medicine and other stock out (Bactrim, INH, milk, food supplements)

USAID HEALTH CARE IMPROVEMENT PROJECT

Key Successes

• Male circumcision campaign

-1734 male circumcised since April 2010 through this initiative.

• Institutionalization of QA at all facilities

• Significant improvements in supported programs

• Establishment of PHC level ART services

• Strengthened linkages between community, clinic and hospital levels

• Absorption of 4 ART( Roving teams) by the district

USAID HEALTH CARE IMPROVEMENT PROJECT

Planned Activities for FY11

1.1 Conduct eight QA trainings for staff at Uthungulu District.

1.2. Contribution to the MDG 4, 5 & 6

MDG 4 : Reducing child mortality by:

- Strengthening PMTCT services

- Continuous monitoring of the programme.

- Ensuring the availability of the latest guidelines.

- Monitoring compliance to the guidelines

- Strengthen IMCI training for both HCWs & CHWs

USAID HEALTH CARE IMPROVEMENT PROJECT

MDG 5 : Improve Maternal Health - Reproductive health/ Family planning

- Promote HIV testing for all clients attending ANC

- Encourage early antenatal booking before 12 weeks of

gestation.

- Strengthen initiation of HIV +ve ANC clients with CD4

count < 350 on HAART

- Promote cervical cancer screening to all vulnerable clients.

MDG 6 : Combat HIV/AIDS, TB & other diseases - Strengthen collaboration of HIV/TB services

- Strengthen CPT & IPT initiation to HIV+ve clients as per

protocol.

Planned Activities for FY11

USAID HEALTH CARE IMPROVEMENT PROJECT

2. 18 Priority districts Uthungulu District is not among the 18 priority districts but, it does offer relevant support for clients that are referred from other districts plus those that cross boundaries.

3. Ministerial priorities. Strengthen HCT implementation at facilities. Strengthen CCMT approach. Scale up MMC universal access. Strengthen implementation of the new PMTCT guidelines. Strengthen 6 ministerial priorities.

4. TB risk assessments and IPC Plan.

Expand implementation of IPC plans and TB risk assessment in all supported facilities.

Planned Activities for FY11

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Thank you