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.