March 2007
MAUN - The white sand and palm trees at the edge of the Botswana's Okavango
Delta give the landscape outside the Maun hospital an almost dreamlike
quality. The reality inside has been more of a nightmare.
HIV-infected patients were waiting an average of 10 hours to get their ARV
medications. Employees were putting in 15-hour work days. Everyone was tired
and angry with the long queues and inefficiencies.
"You can imagine someone who is very sick having to spend their entire day
here before they get help. Some were leaving before receiving their
medications," says Elizabeth Peacock, the chief pharmacy technician at the
hospital's Infectious Disease Care Clinic (IDCC).
A two-week management training course funded by the U.S. President's
Emergency Plan for AIDS Relief (PEPFAR) has helped change all of that. Now,
Peacock says, patient wait time has been reduced to an average of four
hours, staff is properly allocated and people are generally happier.
"A few small management changes have made a world of difference, and people
are starting to feel good about coming here again," she said.
Peacock took part in the Sustainable Management Development Program (SMDP),
a course developed by the Centers for Disease Control and Prevention (CDC)
in Atlanta and used in countries throughout the world with an aim of
improving the way AIDS-related services are delivered.
Since 2000, SMDP trainings have been facilitated by the Institute of
Development Management (IDM), a regional program that serves Botswana,
Lesotho and Swaziland. The training curriculum includes Total Quality
Management (TQM), team building, patient flow analysis and evaluation.
Results have been promising:
- A counseling center in Molepolole increased the number of counseling
sessions by 40 percent, resulting in more clients testing for HIV and
accessing HIV/AIDS services.
- A voluntary testing center in Jwaneng increased the number of mobile
outreach visits to rural villages by 35 percent.
- A primary hospital in Tutume improved on the collection of blood
samples from outlaying clinics and wards. Late arriving samples dropped
from 64 percent to 15 percent.
Between May and June of 2005, a team at the IDCC in Maun handed out time
cards to 300 random patients to determine how much time they spent in each
department - from reception to doctor consultation to pharmacy. From the
analysis it was determined that patients spent an average of 10 hours at the IDCC, with the majority of time spent waiting at pharmacy.
Using techniques learned at the SMDP training, Peacock and her team
determined the roots of the problem and developed countermeasures. Among
other things, the team established an appointment system for returning
patients, started adherence counseling in group sessions, developed a new
staff allocation system and assigned someone to coordinate patients at
check-in.
By April 2006, wait time at the Maun IDCC had been reduced by 52.5 percent -
well beyond the set target of 30 percent, says Peacock.
"The rapport between patients and staff has improved as well as the overall
staff morale. The future is a little brighter," Peacock says.
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