During a site visit with the USAID Health Care Improvement (HCI) Project in Uganda the Quality Improvement team at the Bwera Hospital in the Kasese District showed me data they collected on patients retained from August 2009 to November 2009. They found that only 54 percent of the patients ever started on treatment were still in care. The team leader told me “This is surprising; I thought everybody was here because the clinic is always busy.”
We then discussed ways to improve the situation, and it was decided the health care workers will begin asking patients why they had missed their visits and, more importantly, what they wanted from the clinic so that they wouldn’t miss visits in the future.
My work with the HCI Project supports the Uganda Ministry of Health to implement the Quality of Care Initiative, which aims to improve the quality of HIV services. Over the past ten months, I worked with 14 facilities to ensure that everyone who receives antiretroviral (ARV) medicine remains in care. This entails visiting facilities, such as the one in Kasese, to help them form quality improvement teams, identify areas for improvement, plan improvement projects and measure their performance.
When I returned two months after my initial visit to Bwera Hospital, the team told me that the most common reason for missed appointments was because monthly appointments were hard to keep due to transport problems. The patients asked for two months worth of ARVs to be dispensed so they could come less often. The staff listened to their clients and began distributing a two month supply of ARVs. They were proud to show me that more patients were now keeping their appointments.
Said one patient:
“Traveling to the hospital for drugs every month was very difficult. I would lose 2 days of business every month to travel which also affected my health. When I discussed my problem and suggestions with the health workers, they accepted to give me treatment of more than one month. Now I have an obligation to remain adherent to treatment and keep my appointments to continue enjoying this. My business is not affected anymore and I am able to save money to cater for other things.”
From this experience, I learned that listening to the perspective of patients in health care gives them a sense of relief and satisfaction with care. Health care workers also find the management of patients more fulfilling when the clients are directly involved. Thanks to the American People for making this happen.
Mabel is a Quality Improvement Advisor working with USAID’s Health Care Improvement Project (HCI). HCI is a five-year task order contract issued by USAID to support countries in improving the quality and impact of health services.