TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

DATE OF ASSESSMENT

19/8/2014

SITE INFORMATION

Do Son OPC

To

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)
0%

Total clients under management:

HUMAN RESOURCES
Full-time: 5
Part-time: 4
Total: 9

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

Name

Position

Ba

OPC chief,
doctor
Dong, Quy
Doctor
Ngoc
Nurse,
secretary
Lan Anh
Counselor
Tam
Pharmacist
Phang,
Peer, C&S
Cuong
team

% total clients)
257 (14 Pre-ART/ 243 ART)

Contracted
Part-time
Full time
X
X
X

Gov
Part-time Full-time
X
x
x

X
X
x

Name of OPC chief

Name of PHS
representative

Dr. Dinh Thi Thanh Ba

Dr. Do Thi Minh Nguyet

File assessment data

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USAID/SMART TA

TA Assessment
Summary Results

Result

HUMAN RESOURCES

96%

STRUCTURE AND
ACCESS

85%

DRUG SUPPLY

90%

LABORATORY
CAPACITY

80%

DATA MANAGEMENT

80%

CASE MANAGEMENT

67%

ART/Pre-ART
DELIVERY

40%

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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

80%

Present result

Difference

Score

Pass or fail

60%

18%

Fail

75%

42%

50%

-25%

Fail

75%

75%

100%

100%

Pass

0%

-92%

Fail

80%
85%

92%

96%

3%

Pass

95%

93%

98%

91%

Pass

65%

7%

63%

-15%

Fail

90%

78%

68%

-26%

Fail

80%

94%

100%

48%

Pass

85%

52%

34%

34%

Fail

85%

100%

100%

Pass

80%

77%

Fail

SMART monitoring score

SMART TA classification

Improving

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USAID/SMART TA

No

Issue

HUMAN RESOURCES
Although the two part-time
doctors have been trained with
HIV/AIDS modules, they still lack
of clinical treatment adherences
and the patient chart hasnt been
filled with full information.
Triage nurse fills information into
the logbooks but she is not a
person to provide report.
Reporting is a job of project
secretary. It is one of the reasons
why the data of report is wrong
STRUCTURE AND ACCESS

1.

2.

1.

TB Infection Control: Medical

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

2.

IEC materials: Very few updated

IEC materials available including
updated job aids for staff to use

Solution

Person in charge

Supporter

Other
sources

Deadline

TA provider team and clinical TA

staff of SMART TA provide on-site
trainings for part-time doctors.

TA provider
team and clinical
TA staff of
SMART TA

HP PAC

HP PHS
Coordinator

31/12/2014

Triage nurse should fill information

into the logbooks and reporting.
The project secretary is
responsible to support for triage
nurse to complete this task.

Triage nurse,
project secretary

Do Son OPC
Chief

HP PHS
Coordinator

10/9/2014

Triage nurse,
counselor

OPC PAC

HP PHS
Coordinator

SMART TA, PAC

Do Son OPC

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, HP PHS and PAC to
send more updated IEC materials
to OPC including hand washing

Actual
date of
completio
n

Note

Nov, 2014

October,
2014

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for patient counselling

3.
C
D

DRUG SUPPLY
No current issues
LABORATORY CAPACITY
Sometimes testing machines at
the district health center dont
work well so some regular tests
cannot be done in time.

DATA MANAGEMENT
Documentation: Three logbooks:
ART, pre-ART, daily medical checkup are updated, but the daily
logbook hasnt coded and no
record of the newly registered
patients so that it is very hard to
count those from logbooks.

Documentation: Clinical record

lacked of some information:
updated phone numbers, contact
address of patients and
supporters; photos,
identifications, treatment
adherence evaluation, clinical
stage, date of re-examination, etc.
The doctor is not concerned about
Pre-ART patients

Project secretary was trained on

data report but the triage nurse
fills patients information into the

procedure, safe coughing

guidelines, nutrition for PLWH
- PAC send the latest flipcharts to
Do Son OPC

Do Son District Health Center to

maintain and fix the machines
regularly.
The OPC doctors to ask patient to
do regular test earlier than 6
months.

Do Son District
Health Center

HP PAC

HP PHS

11/2014

Triage nurse to update three

logbooks and update the patient
management excel file every day.
At the end of every month, the
triage nurse count from the
logbooks and check with other
sources such as the excel file and
pharmaceutical source to have a
good data report.
HP PAC usually to check and
support Do Son OPC to verify data.
Doctor and triage nurse to check
all patient charts and update their
contact information regularly.
Doctor to fill in the clinical record
the clinical stage, date of reexamination appointment, how to
use medications, and pay special
attention to Pre-ART
HP PAC usually to check and
support Do Son OPC to fill all the
updated information into the
patient chart review
Project secretary to guide the
triage nurse on how to record in
the logbooks and report.

Triage nurse
Sn OPC

HP PAC

HP PHS

11/2014

Doctor and
triage nurse of
Do Son OPC

HP PAC

HP PHS

11/204

Triage nurse and

project secretary

Do Son OPC

Do Son OPC
Chief

11/2014

OPC doctor

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1.

1.

logbooks so she didnt know how

to draw data from the logbooks to
report.
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.

OPC chief, Triage

nurse,
counselor,
Care and
support team

HP PAC staff

HP PHS
Coordinator

Nov, 2014

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

Do Son OPC:
OPC Chief,
Receptionist,
Counselor, C&S

HP PAC

HP PHS

Nov, 2014

ART/ Pre-ARTDELIVERY

HIVQUAL # 10: Proportion of

patients are tested CD 4 at least 1
in last 6 months is low due to
some reasons:
- Lack of reagent for CD4 test
- Do Son 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

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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 reexamination should be
the same to facilitate the
patients travelling;
Counselor to call to
remind patients before
testing date.
See and Act: HP PHS to check with
the above practice and see it
works or should be changed if
needed.

2.

3.

4.

Data quality issue with proportion

of newly registered patients and
eligible for IPT are prescribed INH
in the last 6 months is low
because the doctor is afraid of
lacking INH
Treatment doctor doesnt know
the situation of TB treatment of
the patient because of lacking
coordination mechanism between
TB unit and OPC.
HIVQUAL # 8: Proportion of
qualified HIV patients are
prescribed for Cotrimoxazole or
DAPSONE for the last visit is low
because the doctor forgets to
prescribe the cotrim when the

Doctor prescribe INH for eligible

patients, especially for Pre-ART
patients.
Pharmacist to increase the
procurement of INH drug
SMART TA in coordination of HP
PHS to improve the coordination
mechanism between HIV OPC and
TB unit

Doctor to comply with guidelines

on prescribing Cotrim or Dapsone.
Triage nurse to check with CD4
results and remind the doctor.

Doctor
Pharmacist

HP PAC

SMART TA
HP PHS

PAC, and HP
TB program

Doctor
Triage nurse

HP PHS

Nov,2014

HP PHS
coordinator

11/2014

HP PHS
coordinator
to check

Nov, 2014

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patients are eligible. Doctor has
stopped the Cotrim when
CD4250 according to the national
guideline and forget to continue
to prescribe Cotrim

5.

OPC- OPC referral, and referral to

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

SMART TA will supports Hai Phong

PHS in performing and promoting
successful referral with the
support implementation of ACISsoftware and patient navigators
Do Son OPC to appoint one staff
to keep track of referral and have
logbook to record transfers, photo
referral slips and counselor to
provide counseling as appropriate

SMART TA
HP PHS
Do Son OPC

HP PAC staff

HP PHS
coordinator

Nov, 2014

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