Standards-Based Management and Recognition (SBM-R): A Tool for Improving the Quality of PMTCT Services A Case Report for

r the Zambian Defense Forces (ZDF) Health Facilities

Authors
Maureen Chilila, RM, MSc; Hilda Shasulwe, RN, RM; Joseph Banda, MD, MPH; Kwame Asiedu, DEGREES? ; Joseph Nikisi, MD, MPH; Webby Kanjipite, MDS; Lt. Col. Joyce Mulilo, RN, RM

Description of the Problem

Zambia has a total population of 13.3 million (2010). The national HIV prevalence rate is 14.3%: In pregnant women: 16% The majority of HIV infection in infants occur through mother-to-child transmission (MTCT). The military has not been spared from the pandemic. They have a high prevalence rate compared to the general population.

Description of the Problem The Zambia Defense Forces (ZDF) runs a parallel health system to the public health sector. ZDF has a network of 54 health facilities representing 16% of all health services in Zambia.

Description of the Problem

ZDF has not received the same level of funding as the public sector, leading to:
Limited and unequal availability of HIV prevention, care and support services, Constrained human, material and systems resources to deliver PMTCT services, and Little on-site support for the transfer of training and implementation of quality services.

As with the rest of the Zambian public health system,

the management of health services to support and ensure quality of care required strengthening.

DFMS* Units
* Zambia Defense Force Medical Services

Question from Dana: does midium below = medium?

Mbala

Ndola
ZA Tug-Argan (2ZR) /25 LAD ZA Kalewa (10 Midium)/ School of Artillery 17 Calvary 1 Commando ZA Mushili (3 Infant Brigade HQ)

ZNS Mbala ZAF Mbala

Kasama
ZNS Kasama

Kabwe
ZA Miltez/OTF Chindwin (ZA 16 Tails) ZNS Kabwe ZAF Kabwe

Mansa
ZNS Mansa Luamfumu
(ZA Luapula HQ)

Solwezi
ZNS Katandano ZNS Kamitonte
(ZA NW HQ)

Mpika Mufulira Kitwe

1 Engineering ZNS Mpika

Lundazi
ZNS Lumezi

Ndola ZNS Kitwe ZA ZCCF Kitwe Kasempa

ZNS Mumbezhi

Serenje
ZA Kanona

Mkushi
ZNS Munsakamba ZNS Luanshimba

Chipata
ZA Gondar

Katete

Kaoma

Chibombo Mumbwa

Kabwe

Nyimba
ZNS Nyimba

ZA Kaoma ZAF Mumbwa ZNS Mangango

ZNS Chisamba

ZNSChiwoko ZNS Mtetezi Lusaka

(ZA Eastern HQ)

Lusaka Chongwe
ZNS Chongwe ZA Mikango

Kafue
ZNS Kafue

Choma
Choma ZNS

Maina Soko Military Hospital Air HQ Arakan 1ZR / Army HQ ZAF Logistic Command L 85 ZNS Safaris Staff college ZNS Chamba Valley (1 BRIDGE Emmasdale) ZNS Lusaka West Builders (ZA Central Mechanical Depot) Brigade (ZECCO Camp) ZNS HQ (ZA Burma Clinic) ZNS Makeni ZNS Sopelo ZNS Airport Farms ZNS LDB HQ ZAF Mt. Eugenia ZAF Twin Palm ZAF Lusaka

Livingstone
ZAF Livingston

Northern Central

Eastern Lusaka Southern Copperbelt Western Luapula Northwestern

School of Ordinance (ZA Southern HQ)

Project Goal
To reduce the spread of HIV and AIDS and mitigate the impact of the epidemic by building the capacity of the Zambian Defense Force (ZDF) to both prevent infections and provide treatment and care
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Approach

Introduction of SBM-R approach as a way to improve the quality of services and various support systems

Approach
SBM-R a quality improvement process that uses a set of detailed standards for the various reproductive health components

Approach
Training of providers and mentorship for improved skills for providers I need a picture on mentorship especially group education

Mentorship in antenatal care at ZNS Mtetezi camp clinic

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Approach
Provision of data management tools to capture the information on PMTCT program implementation and service utilization I need a picture with registers or any form of documentation

Data management using electronic medical records (SmartCare)

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Approach
Procurement and distribution of equipment and supplies for service provision

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Results
Comprehensive PMTCT services such antenatal care, labor and delivery, postnatal, family planning and child health care have been initiated in all model sites, with the performance of providers markedly improved, as demonstrated by the achievement of standards in the various areas. All the sites have received supportive supervision visits and mentorship. .
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Results
The initiative resulted in a steady increase in service uptake over the years. 11,207 mothers have been counseled and tested. Seven in every 10 positive pregnant women were provided with ARVs during the PMTCT program. Of these, 13% (1,436) tested HIV-positive.

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Results
277 (3%) pregnant women already knew their HIV status at entry. 853 exposed babies have been tested for HIV using the PCR and have been appropriately managed. The positivity rate of exposed babies has decreased from 14% to 5%.

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Conclusion
The program data so far have shown that it is possible for quality PMTCT services to be scaled up to the ZDF health facilities and to increase the number of infected women benefiting from the PMTCT program in Zambia.

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