TA PLAN

USAID/SMART TA
ASSESSMENT PERIOD

1/10/2014

ASSESSMENT DATE

14/8/2014

OPC NAME

Dong Hung OPC

To

30/6/2014

SERVICE DELIVERY

ARV adult
ART pediatrics

HTC

MMT

PLTMC

HBC

Out-reach

TB

STI

REGIONS/AREAS

Urban

Rural

Mountainous area

OTHER
CHARACTERISTICS

Clients in closed setting

<1

%)

Clients of ethnic minority

(
<1
%)
Total of client under management: 210 (16 PreART, 194 ART)

HUMAN RESOURCE
Thai, Hang: Doctors
Phuong, Dong: Nurse
Gam: Pharmacist
Hoa: Counselor
Mai, Chuan: others

Part-time

Assessment
Categories

Others

Total

1
2

OPC head

PAC representative

Dr. Trn Vn Thi

Dr. Huy Giang

Result

HUMAN RESOURCE

88%

STRUCTURE AND
ACCESS

79%

DRUG SUPPLY

70%

LABORATORY
CAPACITY

80%

DATA MANAGEMENT

100%

CASE MANAGEMENT

67%

ART/Pre ART delivery

Full-time

2
2
1

USAID/SMARTA
site monitors
MA. inh Th Bch Hnh

70%

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TA PLAN
USAID/SMART TA
HIVQUAL and SMART TA monitoring indicators

N0

Indicators

Standard

Last result

Current
Result

Difference

Catagorized

100%

100%

Satisfactory

Proportion of patient chart over 80% of chart audit scoring

80%

Proportion of client newly registered at the OPC in last 6 months

and tested for CD4 within 15 days of enrollment

65%

100%

60%

-40%

Unsatisfactory

Proportion of pre-ART patients visiting the OPC regularly and per

appointment with doctor

75%

100%

94%

-6%

Satisfactory

Proportion of newly registered patients and eligible for IPT are

prescribed INH in the last 6 months

80%

0%

0%

Unsatisfactory

Proportion of ARV patients visiting the OPC for medication pickup according to scheduled appointment in the last visit

85%

97%

97%

0%

Satisfactory

Proportion of ARV patients who are assessed for medication

adherence in the last visit

95%

100%

100%

0%

Satisfactory

Proportion of patients were initiated ART within 15 days after

qualification in last 6 months

75%

100%

88%

-12%

Satisfactory

Proportion of qualified HIV patients are prescribed for

Cotrimoxazole or DAPSONE for the last visit

90%

100%

94%

-6%

Satisfactory

Proportion of patients are screened for TB in the last medical visit

80%

100%

100%

0%

Satisfactory

10

Proportion of patients are tested CD 4 at least 1 in last 6 months

85%

86%

76%

-10%

Unsatisfactory

11

Proportion of ART clients still alive after 12 months of ART

85%

91%

91%

Satisfactory

12

Proportion of clients retained in care during the last 12 months

80%

100%

SMART TA Score
SMART TA site classification

Satisfactory

5
Effective

TA Need Assessment File:

File nh gi d n
USAID/ SMART TA

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TA PLAN
USAID/SMART TA

No
A

Issue
HUMAN RESOURCES
Reception nurse who has recently
replaced the former nurse retired
does not have much experience in
data management and providing
counselling support to patients.

Person in
charge

Supporter

Other
sources

Deadline

The OPC to assign experienced staff in

data management to provide more
guidance to the new reception nurse

OPC Chief

Reception
nurse, C&S

Nov, 2014

SMART TA, PAC TB to send more updated

job aids such as flipcharts for patient
counselling

SMART TA;
Coordinator
of PAC TB

10/2014

Standard precaution tools such as

hand washing procedure, safe
coughing guidelines are not yet
available

SMART TA, PAC TB to send standard

precaution tools such as hand washing
procedure, safe coughing guidelines

SMART TA,
Coordinator
of PAC TB

Dong Hung
Health
Center,
Dong Hung
OPC
Dong Hung
Health
Center,
Dong Hung
OPC

Staff have not been trained about

standard precaution procedures and
there is no reference document of
standard precaution

Health center provides opportunities for

OPC staff training about standard
precaution procedures issued by MOH

Dong Hung
Health
Center

Dong Hung
OPC

10/2014

Thai Binh PAC to coordinate to provide

more fungal medications to Dong Hung
OPC according to the proposal from Dong
Hung OPC
SMART TA clinical staff to see clinical
record of the patients who are in fungal
treatment to support for those patients.
Accountant of Thai Binh PAC in
collaboration with Dong Hung accountant
to send the financial report in time

Coordinator
of PAC Thai
Binh

Site monitor
of SMART
TA

30/11/2014

STRUCTURE AND ACCESS

Very few updated job aids such as
flipcharts for patient counselling

Solution

DRUG SUPPLY
OI drugs especially fungal medication
were not adequately supplied during
evaluation period due to a number of
reasons:
- Life-gap sends letter instructing on
drug supply late.
- Budget for each OPC is allocated to
number of patients and number of
patients requiring fungal skin
treatment is high.
- Patients do not take fungal
medications as dose causing
repeated infection.

TB units

Actual date
of
completion

10/2014

SMART TA
clinical staff
Accountant
of TB PAC
and Dong
Hung OPC

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Note

TA PLAN
USAID/SMART TA

- Financial statements are often

submitted late thus there is no
advanced money to buy drugs.
PRE-ART AND ART DELIVERY
HIVQUAL # 1: Proportion of client
newly registered at the OPC in last 6
months and tested for CD4 within 15
days of enrollment is low due to
some reasons:
- Lack of reagent for CD4 test
- Provincial hospital returns CD4
result late
- Follow-up of patients in early
treatment must be improved.

HIV QUAL # 3: Proportion of newly

registered patients and eligible for
IPT are prescribed INH in the last 6
months is low due to:
- Doctors are reluctant to prescribe
INH due to fear of lacking drug
- Doctors are not concerned about
prescribing INH for pre-ART patients
HIVQUAL # 10: Proportion of patients
are tested CD 4 at least 1 in last 6
months is low due to some reasons:
Lack of CD4 reagent

QI PDSA Activity #1
Plan: Increase the proportion of client
newly registered at the OPC in last 6
months and tested for CD4 within 15 days
of enrollment.
Do:
Chief of Dong Hung OPC to organize
weekly meeting to review all newly
registered patients to avoid omitting
patients that are eligible for
treatment, need CD4 and other
routine tests.
Doctor to discuss with the newly
registered patients on the earliest
appointment date for CD4 and other
routine tests
Counselor to provide patients the
importance of CD4 and other routine
laboratory tests
Counselor to call to remind patients
before testing date
See and Act: TB PAC to check with the
above practice and see it works or should
be changed if needed.
Doctor to prescribe INH for Pre-ART
patients.
Pharmacist increases INH proposal to
have more INH medication for patients

OPC Chief

Reception
nurse,
counsellor,
C&S

Nov, 2014

Treatment
doctor

Reception
nurse

Nov, 2014

QI Activity #2:
Plan: Increase the proportion of patients
are tested CD 4 at least 1 in last 6 months.
Do:
Chief of Dong Hung OPC to

OPC Chief

Reception
nurse,
counsellor,
C&S

Nov, 2014

Pharmacist,
Accountant
of Dong Hung
Health
Center

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TA PLAN
USAID/SMART TA
- Follow-up of patients for CD4 test
must be improved

HIVQUAL # 1: Proportion of patients

were initiated ART within 15 days
after qualification in last 6 months is
low due to receiving the CD4 results
late (after 1-2 weeks)
4

organize weekly meeting to

review all patients to avoid
omitting patients that are eligible
for treatment, need CD4 and
other routine tests.
Doctor to appoint the test date
earlier than 6 months.
Triage nurse to check who will
have CD4 test and remind the
doctor on that by sticking a
yellow sticker on the medical
record.
Counselor to provide patients the
importance of CD4 and other
routine laboratory tests before
the regular test date;
Doctor to discuss with patients
the appointment date for CD4
and other routine tests,
The appointment date for testing
and re-examination should be
the same to facilitate the
patients travelling;
Counselor to call to remind
patients before testing date.
See and Act: TB PAC to check with the
above practice and see it works or should
be changed if needed.
QI PDSA Activity #3
Plan: Increase the proportion of patients
who were initiated ART within 15 days
after qualification in last 6 months.
Do: PAC to discuss with the provincial
hospital to send CD4 test results via
telephone, then send the official result
later.
See: PAC to check if there is any
difficulties of sending CD4 test results via
telephone.
Act: Continue to send the CD4 test results
via telephone or change as appropriate
based on the factual situation

Coordinator
of PAC TB

Counsellor

Nov, 2014

Reception
nurse, Dong
Hung OPC

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