Patient Care Clinical Trial
Official title:
CIDRZ 1229- Better Health Outcomes Through Mentoring and Assessment (BHOMA)
BHOMA Interventions
The purpose of this study is to assess the impact of the BHOMA intervention on health in 3
rural districts of Zambia.
The BHOMA study includes systematic program implementation designed to contribute to
generalizable knowledge and evaluation of this program. The program aims to improve primary
health care through an integrated package of interventions, at both health facility and
community level, centered on improving the patient -provider interface which is considered
to be key to improving health outcomes. The primary objective of this research is to assess
the impact of the BHOMA intervention on health in three rural districts of Zambia.
Objectives include: to understand the causal pathways of the BHOMA interventions by
analyzing inputs, processes, outputs, and outcomes; to measure the cost of the BHOMA
interventions; and to measure whether the health system has been strengthened by the BHOMA
interventions. The endpoints of the study will be measured by a combination of facility
surveys, facility health worker and community health worker interviews, quality assessments,
qualitative studies and community surveys.
The study involves 7 stepped introduction of the programme in 48 facilities. A step
typically involves initiation of a set of selected health facilities and the communities
they serve. On average, 6 randomly selected sites are involved in a step. Facility workers
are trained; community health workers, clinic support worker and traditional birth
attendants are identified and trained through a month-long Ministry of Health (MOH) approved
course. Equipment for data collection and electronic capture are set up, filing systems
established and the study begins when the tools get implemented. Close supervision is
provided for at least a month following initiation; there after regular supervisory visits
are done by six quality improvement teams.
Clinic Intervention, implemented by the Centre for Infectious Disease Research in Zambia
(CIDRZ) BHOMA program:
The clinic intervention consists of the following 5 components: 1) the implementation of
clinical care forms and accompanying job aids, 2) resources, to includes equipment,
supplies, staffing and infrastructure, 3) clinic implementation, which involves a quality
improvement team working at the clinic to introduce the new patient flow system and to
improve the skills of clinic staff, 4) the use of electronic information for performance
assessment, which involves implementing an electronic data entry system within the clinics
and 5) supportive mentoring, which will involve the Quality Improvement (QI) team reviewing
patient charts for appropriate screening, diagnostics, treatment or follow-up, attending
patient visits, identifying equipment or infrastructure issues, and reviewing clinic
performance reports and updating the clinic's quality improvement strategy.
Community Intervention, implemented by the CIDRZ BHOMA program:
The community intervention aims to expand the availability of community-based health
services and improve the quality of these services with the use of three groups:
Community Health Workers:
The investigators will engage one community health worker (CHW) per Neighborhood Health
Committee to conduct patient follow-up and household assessments. The CHWs will use two
forms - patient follow-up form and a household assessment form, and will be trained to
assess which patients need referral to the clinic or hospital.
Traditional Birth Attendants:
The investigators will offer training for traditional birth attendants (TBAs) working near
the implementation clinics. The training will review the goals of facility delivery and
introduce a pregnancy referral form for TBAs. The investigators will encourage the TBA to
help the patient arrive at the clinic, and provide incentives for the TBAs for clinic
referrals. The investigators will also train the TBAs to follow up all pregnancies in the
first month to assess the infant and teach the mother about when it is appropriate to bring
the infant to the clinic. TBAs will complete infant follow-up forms.
Neighborhood Heath Committees (NHC):
These committees will complete a community health event register, during which they will
capture information about serious sicknesses and deaths that are not recorded at the
clinics. Each NHC will visit households and return their register to the clinic.
These activities will continue throughout the duration of the funded project.
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