TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

To

DATE OF ASSESSMENT

7/8/2014

SITE INFORMATION

Mong Cai OPC

30/6/2014

SERVICES PROVIDED

ARV for adults

ARV for children

HTC

MMT

PMTCT

C&S

Out-reach

TB

STI

AREA

City

Rural

Mountainous

OTHERS

Clients in prison

Ethnic group clients

% total clients)
4%

Total clients under management:

HUMAN RESOURCES
Full-time: 7
Part-time: 0
Total: 7

Name

Position

Hi

OPC chief,
doctor
Doctor
Nurse,
secretary
Counselor
Pharmacist

Hng
Vng
Uyn
Hng,
Hn, Qu
Hi

Name of USAID/SMART
TA provincial site
monitor
MA. Dinh Thi Bich Hanh

Peer, C&S
team

% total clients)
310 (40 Pre-ART/ 270 ART)

Contracted
Part-time
Full time
X

Gov
Part-time Full-time

X
X
X
x
X

Name of OPC chief

Name of PAC
representative

Dr. L Th Hi

Dr. Le Thi Hoa

File assessment data

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USAID/SMART TA

TA Assessment
Summary Results
A
B
C
D
E
F
G

HUMAN
RESOURCES
STRUCTURE AND
ACCESS
DRUG SUPPLY
LABORATORY
CAPACITY
DATA
MANAGEMENT
CASE
MANAGEMENT

Result
96%
82%
90%
90%
90%
50%

Not yet
ART/Pre-ART
implemented
DELIVERY
HIVQUAL

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USAID/SMART TA
SUMMARY RESULT OF HIVQUAL AND SMART TA INDICATORS
SMART TA
Standard

No Indicator

1
2

4
5
6

8
9
10

Proportion of medical record is more than 80%

of score used the patient chart review tool
Proportion of patients who newly registered at
the OPC in last 6 months are tested for CD4
within 15 days of enrolment
Proportion of pre-ARV patients who visit the
OPC regularly (according the national guideline
every 3 months and per appointment with
doctor)
Proportion of patients who were newly
registered at OPC was prescribed INH
Proportion of ARV patients visiting the OPC for
medication pick-up according to scheduled
appointment in the last visit
Proportion of ARV patients who are assessed
for medication adherence in the last visit
Proportion of patients were initiated ART within
15 days after qualification in last 6 months
Proportion of qualified HIV patients are
prescribed for Cotrimoxazole or DAPSONE for
the last visit
Proportion of patients are screened for TB in
the last medical visit
Proportion of patients are tested CD 4 at least 1
in last 6 months

Proportion of patients who still alive and on

treatment after 12 months on ART (NGI ID)
Proportion of patients retained in care after 12
12 months of registration (SMART TA
recommended ID)
11

Last round result

Present result

Difference

Score

Pass or fail

60%

60%

Fail

75%

0%

Fail

75%

0%

Fail

80%

0%

Fail

85%

0%

Fail

95%

0%

Fail

65%

0%

Fail

90%

0%

Fail

80%

0%

Fail

85%

-95%

Fail

-4%

Pass

Pass

80%

85%
80%

95%

91%
89%

SMART monitoring score

SMART TA classification

Improving

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USAID/SMART TA

No
A

1.

Issue

Solution

Person in
charge

Supporter

Other
sources

Deadline

Actual
date of
completio
n

Note

HUMAN RESOURCES

Staff Integration: Mong Cai OPC

staff is fully on contract paid, thus
not able to participate in routine
activities of the hospital, such as
attending the regular meetings in
the hospital, including related
environmental content, standard
precaution.

Integrate step by step Mong Cai OPC

into the infectious department of
Mong Cai General Hospital, then
contribute to sustainable transfer.
QN PAC to discuss with Director of
CP General Hospital to send the
doctors and staff to the OPC to learn
and work instead of contracted staff.
Mong Cai General Hospital involves
OPC staff in regular activities,
especially regular meeting of the
hospital.
One or two part-time staff to replace
the contracted staff in the next SA.

QN PAC and
MC General
Hospital

QN PHS

31/12/2014

STRUCTURE AND ACCESS

1.

TB Infection Control: Medical

mask available but not welldelivered to needed patients (TB
suspected/ coughing patients)

2.

IEC materials: Very few updated

QI PDSA Activity #1
Plan: Implement active TB infection
control and prevention
Do:
- Triage nurse distributes medical
mask for needed patient (TB
suspected/coughing patients)
- Counselor provides counseling
session for the TB
suspected/coughing patients to
understand the importance of
medical mask wearing.
See: After 1 month, the OPC counts
how many medical masks have been
distributed and if they are provided
appropriately for the TB
suspected/coughing patients.
Act: Triage nurse leads discussion of
data and team provides feedback,
solutions, and plan for ongoing
monitoring.
- SMART TA, PAC to send more

Triage nurse,
counselor

OPC Chief

SMART TA,

Mong Cai

QN PAC staff
monitor
infectious
control
procedures
and check
regularly

Nov, 2014

October,

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USAID/SMART TA
IEC materials available including
updated job aids for staff to use
for patient counselling

3.

C
D
E

Environmental Waste
Management: No classified bin
such as bin for medical waste, i.e.
cotton, bandages, alcohol, swabs
with patients blood, etc and bin
for domestic waste
DRUG SUPPLY
No current issues
LABORATORY CAPACITY
No current issues
DATA MANAGEMENT
Documentation: Clinical record
has been filled with relatively
adequate information but not
updated with phone numbers,
contact address of patients and
supporters. The clinical record
lacked of date of re-examination
appointment, photo, identification
papers of the patients.

The number of LTFU and stop

treatment patients is not counted
exactly since the OPC counted
wrongly the time.

Mong Cai OPC lacks of a cabinet to

keep clinical records so the clinical
records of patients who stopped
treatment, died or lost-to-follow-

updated IEC materials to OPC

including hand washing procedure,
safe coughing guidelines, nutrition
for PLWH
- PAC send the latest flipcharts to
Mong Cai OPC

PAC

OPC

2014

Mong Cai OPC

Mong Cai
General
Hospital

Oct, 2014

Triage nurse,
counselor,
C&S

QN PAC staff
to check

Nov, 2014

Triage nurse and counselor follow-up

closely to count exactly the number
of patients who dont come to the
OPC for re-examination, CD4 and
other routine test. LTFU means PreART patients who havent come to
the OPC for re-examination for 6
months since the date of last reexamination. Stop treatment means
ART patients who havent come to
the OPC for 3 months since the date
of last re-examination.

Triage nurse
Counselor

QN PAC staff
to check

Nov, 2014

The OPC to propose to purchase

more cabinet

Project
secretary
OPC Chief

Mong Cai
General
Hospital

- OPC Mong Cai to request more bins

for medical waste and use coloured
nylon bags to classify waste from
hospital administration

Triage nurse, counsellor, C&S team

to talk to patients and their
supporters to update their contact
information regularly

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USAID/SMART TA

1.

2.
G

up havent been kept separately.

CASE MANAGEMENT

Patient Follow-up: Follow-up of

referral cases, patients late reexamination, poor treatment
adherence must be improved.

QI PDSA Activity #2
Plan: Increase the rate of retention
in care of the all the patients
including Pre-ART and ART
Do: Triage nurse records late reexamination, referral cases, phone
to them to remind for reexamination, confirm the successful
referral. Counselor provide
counseling session to the patients on
benefits of early treatment,
significance of treatment adherence,
etc; implementation of LTFU SOP
See: Check with the number of
patients who show late reexamination and poor treatment
adherence and see the records at
the record books.
Act: Continue with the action above
or change as appropriate.

Triage nurse,
counselor,
Care and
support team

QN PAC staff
to check

Nov, 2014

QN PAC
Mong Cai OPC

QN PAC
Mong Cai
OPC

11/2014

QN PAC
Mong Cai OPC

Provincial
General
Hospital

Nov, 2014

ART/ Pre-ARTDELIVERY

1.

The proportion of newly

registered patients and eligible for
IPT are prescribed INH is low

2.

The proportion of patients were

initiated ART within 15 days after
qualification is low due to:
- Follow-up of patients in early
treatment must be improved.

Doctor to prescribe INH for Pre-ART

patients.
Pharmacist increases INH proposal
to have more INH medication for
patients.
QI PDSA Activity #3
Plan: Increase the proportion of
patients who were initiated ART
within 15 days after qualification.
Do: PAC to discuss with the
provincial hospital to send CD4 test
results via e-mail.
See: PAC to check if there is any
difficulties of sending CD4 test
results via e-mail.
Act: Continue to send the CD4 test
results via e-mail or change as
appropriate based on the factual
situation

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USAID/SMART TA

3.

3.

The proportion of patients are

tested CD 4 regularly is low due to
some reasons:
- Mong Cai OPC appoints the test
date of 6 months so when the
patient is busy or sick, he/she will
be late for CD4 test.
- Follow-up of patients for CD4
test must be improved

OPC- OPC referral, and referral to

other services must be improved
to follow-up with the patients.

QI Activity #4:
Plan: Increase the proportion of
patients are tested CD 4 at least 1 in
last 6 months.
Do:
Chief of Mong Cai OPC to
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: QN PAC to check with
the above practice and see it works
or should be changed if needed
SMART TA will supports PAC Quang
Ninh in performing and promoting
successful referral with the support
implementation of ACIS-software

QN PAC
Mong Cai OPC

SMART TA
QN PAC
Mong Cai OPC

Nov, 2014

QN PAC staff
to check

Dec, 2014

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TA PLAN FORM (v 4.8.14.0)

USAID/SMART TA
and patient navigators
Mong Cai OPC to appoint one staff
to keep track of referral and have
logbook to record transfers, photo
referral slips

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