Team PATA

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2007 Newsletter, Vol II Issue 4

Working together to improve and extend care for children and families affected by HIV/AIDS.

In this issue:

1. Reporting back on progress since PATA Nairobi
2. PATA 2007 set for Swaziland
3. Mentors for PATA clinics
4. Expert Patient Programme allocations
5. Balanced scorecard for ongoing clinical evaluation
6. TASO Mbarara Uganda progressing well with goals
7. Mentor focus: Henry Barigye

1. Reporting back on progress since PATA 2006, Nairobi

Six months have passed since PATA 2006 and much has happened since. Now it is time to evaluate how PATA 2006 has contributed to our work and how far we have come in achieving the goals set out at the Nairobi conference.  

A questionnaire is attached to this newsletter and we would like to ask each clinic that attended PATA 2006 to complete this evaluation form and send it back to us by the 15^th of July 2007. Completed applications can be sent to melanie@teampata.org

We will publish a summary of evaluation data in the August newsletter and on the PATA website (www.teampata.org). Remember that teams that have reported back on and demonstrated progress with regards to their clinic goals set for 2007 will be given preference for financial support to attend PATA Swaziland at the end of this year.

Click here to download the progress report and questionnaire.

2. PATA Swaziland 2007

It’s official! We are very pleased to announce that PATA 2007 will be held in Swaziland from the 27^th of November to the 1^st of December 2007.

Accommodation costs for a four-person clinic team (consisting of a medical officer, nurse, counsellor and pharmacist) will be covered by PATA. First time attending clinic teams will have their transport costs covered if they are unable to pay for their own flights.

Teams which attended PATA Cape Town 2005 or PATA Nairobi 2006 are encouraged to find their own funding to cover their transport costs to the conference. PATA teams who can demonstrate attempts to find their own funding but require additional financial support from PATA, should contact PATA at melanie@teampata.org. Teams who have already attended a PATA conference and who are working on projects will be expected to provide progress reports at the next conference. Please read through section 5 of the balanced scorecard to see how your team can evaluate their clinic’s performance.

A conference programme and further details on PATA Swaziland follow in our next newsletter.

3. Mentorship

All clinics which attended PATA Nairobi were allocated regional mentors.

The mentorship initiative has many aims. Mentors will be able to assist clinics in developing self-improvement projects and to network in order to share expertise with other clinics within their region. Mentors and clinics can work together to identify challenges and obstacles facing the progress of the clinic.

PATA would like to extend this facility to all PATA clinics, including those who did not attend PATA Nairobi.

Teams that are unclear about who their mentor is or who would like additional information on the mentorship programme are encouraged to contact Melanie
(melanie@teampata.org) for further details.

4. Expert Patient Programme Update

The Expert Patient Programme submission date has passed and the PATA steering committee has approved funding allocations to all the clinics that applied for Expert Patient Funding. This exciting new pilot project will see 74 Expert Patients being
employed at clinics throughout Africa from the 1^st of July 2007.

Clinics that applied for funding provided a brief job description for their Expert Patients and an outline of training for PLWHA meeting criteria for employment. A maximum of US$200 per month per clinic has been allocated.

There is a creative array of jobs awaiting expert patients. A number of clinics want play area supervisors and adherence monitors to do community visits. Others need funding for feeding assistants, administrative clerks and support group facilitators.

Each participating clinic in this pilot programme will have a supervisor within their clinic, working closely with their PATA regional mentor. Measurable outcomes will be identified so that the impact of this programme can be assessed. Details of these clinics and their mentors are summarised below:

Participating clinics are encouraged to contact their mentors to select measurable indicators for the pilot project. A detailed report on the progress of the pilot will be due on the 1^st of November 2007.

5. A balanced scorecard can improve your clinic’s performance – here’s how

At PATA Nairobi 2006, the need was identified for clinics to help run themselves better by using a system called the ‘balanced scorecard’. The balanced scorecard was originally developed by Drs Robert Kaplan and David Norton and then applied to PATA clinics’ needs by Dr Paul Cromhout. This balanced scorecard would need to provide staff at any clinic with easily identifiable and, most importantly, measurable, indicators to help them gauge in which areas they need to improve their performance.

To achieve best practice in your clinic, you need to know which outcomes to measure. At the conference, a sample of seven clinics offered their suggestions of which outcomes should be measured (and which indicators employed to do so) or are ones which they were already keeping track of at their clinics.

The outcomes currently being measured ranged from measuring adherence by monitoring someone’s attendance to the clinic and the medication regimen to simply capturing data such as weight and hospital admissions properly in order to gauge the efficacy of ARVs. Access to care would, for example, be measured by monitoring the rate of enrolment at the clinic and the average waiting time for HIV-positive children until they could go on ARVs.

But what exactly is a balanced scorecard? How does it work in practice? And once all the data is captured, how does one analyse it in order to make your clinic a better place for the people – the children – who need it most?

5.1 What is a balanced scorecard?

It is a management system (not only a measurement system) that enables organisations to clarify their vision and strategy and translate them into action. It provides feedback around both internal processes and external outcomes in order to continuously improve strategic performance and results.

For our use, the ‘organisation’ is the clinic.

The balanced scorecard suggests that we view the clinic from four perspectives and to develop indicators, collect data and analyse it relative to each of these perspectives.

These perspectives are as follows:

1. The business process (internal systems and infrastructure perspective)
2. The client perspective
3. The financial perspective
4. The learning and growth perspective

A key aspect to improving work and learning is that, when we set too many objectives and targets and try to measure them, we often get lost in an administrative mess.

The most effective measures/indicators are those that are chosen by the organisation or team on the basis of these being the most important measures of achievement of strategic objectives. Simply put: clinic staff must decide what should be monitored at their clinics which would help them to serve their communities better.

5.2 How does it work in practice?

Each clinic gets together in a workshop session and asks themselves this: What do we dream of accomplishing? And what is the best strategy to get us there?

Now look at your clinic from the above four perspectives:

1. The business process: to satisfy your partners and clients, what processes and systems must the clinic excel at? Now you set an initiative, targets to work towards in following up that initiative, you set measures by which you can gauge whether things are working or not and, finally, you set objectives.
   
2. The client perspective: if you want to serve your clients and community as best as possible, what must be done? Work through the same process now, from initiatives set, to targets, to setting measures to setting objectives.
   
3. The financial perspective: to sustain and grow financially, what does the clinic need to do? Again – initiatives, targets, measures and objectives.
   
4. The learning and growth perspective (the PATA effect): to achieve your vision, how will the clinic sustain its initiative and change and improve what needs to be done? Again - initiatives, targets, measures and objectives must be set.

5.3 Which measurable indicators and outcomes apply most to PATA clinics?

From the PATA process, the following key areas have emerged after clinic tasks were reviewed:

• Patient-centred systems and staff activities.
• Space and infrastructure related tasks
• Patient support tasks (psychosocial)
• Community support activities
• Training and mentoring activities

It is important that only three or four indicators or measures are chosen per key area, otherwise the balanced scorecard becomes too complicated. Below are some examples of indicators that could be applied to the four perspectives within your clinic.

Please let the PATA team know what your targets, indicators and objectives are so that we can share them with each other and identify common themes. To download an example of a balanced scorecard template, click here.

5.4 How will PATA use your balanced scorecard?

At the end of each quarter the results/progress in terms of the scorecard are tabulated and disseminated to the team and partners and improvements or adjustments are made.

The scorecard is then evaluated by partners (clients, funders, etc) and the clinic team and a revised or new scorecard developed for the next year.

Such a strategic management system is used routinely in many organisations throughout the world.

It is hoped that this method may be of useful application to your centre and that we can develop a way of continuously improving our practice and services to our clients (the children and their caregivers) and our partners.

6. TASO Mbarara Uganda progressing well with their goals set at PATA 2006

The TASO clinic in Mbarara (Western Uganda) was founded in 1989 and is currently staffed by nine nurses, six doctors, 20 counsellors, and two pharmacists. It serves a large rural hinterland around Mbarara – a community of about 30 000 people.

At the conference PATA 2006 conference in Nairobi, they selected the initiatives focusing on psychosocial support, strengthening community mobilisation for paediatric ART, a better nutrition programme and creating a child-friendly environment as short to medium term non-medical goals.

So far, they are making excellent progress with their goal of providing psychosocial support. They have established peer support groups for children and are in the process of setting up more groups. An exciting initiative has been a radio talk on paediatric ART and HIV care. The guest speaker at their end of year fellowship was a child who gave a beautiful speech about paediatric HIV care, ART and the role of adults in caring for the children.

They are also in the process of developing a paediatric newsletter for their centre. The newsletter will be sent to community AIDS workers to help the process of community mobilisation. Snacks and nutrition are now provided to children on clinic days.

A bigger play centre with more toys has been established. Future ideas for creating a child-friendly clinic include plans for an outdoor play site at the clinic and improving client flow so that their paediatric clients are attended to first. This will allow the kids enough time for play therapy.

According to Dr Henry Barigye, the clinic’s PATA mentor, the following challenges still lie ahead for TASO Mbarara.

• Toxicity screening isn’t done because the clinic lacks a clinical chemistry laboratory.
• While early infant diagnosis is done, the results take too long to be received because the reference laboratory in Entebbe has many HIV service providers it has to serve.
• Financial assistance for scholastic support and apprenticeship is also a challenge. Currently, only a few selected children benefit because of limited funds.
• Client follow-up is problematic as some clients live more than 75 km from the clinic. Sometimes clients miss their appointments because they genuinely lack the transport to come for the services either at the centre, outreaches or drug distribution points.
• The clinic still struggles to get the correct age appropriate IEC materials.
• Medical goals that were set at PATA 2006 included ART scale-up, computerising their laboratory system, gaining access to child friendly ARVs and to set up paediatric ART child counselling training.

To date, multiple entry points and facility outreaches have been used to increase ARV enrolment. The laboratory system has been computerised, and this has made immunological monitoring much easier.

Paediatric formulations of the ARVs are being used and most of the counsellors at the clinic have been trained in child counselling. In addition, two field officers and one nurse have also had this training whilst some staff have been on a paediatric refresher course.

The clinic is managed by Dr Catherine Nabaggala (ART Team Leader) who works hand in hand with the paediatrician, Dr Andrew Kiboneka.

7. PATA mentor focus: Dr Henry Barigye

The TASO clinic in Mbarara is just one of the clinics mentored by Henry Barigye under PATA’s mentorship programme. He also mentors clinics from Botswana, Swaziland and Ethiopia.

We asked Henry a few brief questions:

PATA: When did you first become involved in PATA?
Henry Barigye: My involvement with PATA started way back in 2004 when we were invited to Cape Town by Paul Roux and KIDZPOSITIVE to share experience on the provision of ART in children. Later I was invited as part of a team from MRC-Uganda to attend the first PATA conference in 2005 - again in the lovely Cape Town.

PATA: What is the most exciting part of mentoring?
HB: When I get to know the amazing things people are doing - often with limited resources.

PATA: What are the biggest challenges you face in your region?
HB: Communication! Communication! I failed to get into regular contact with some centres and often my own internet is down.

Please send us news from your clinic – we would love to hear from you!

Contributors to this edition:
Paul Cromhout, Dr Henry Barigye, Melanie Evans & Paul Roux.

P.O. Box 13657, Mowbray,
South Africa, 7705.
T: +27 21 404 3020
F: +27 21 406 6169

www.teampata.org

Published online from
the Republic of South Africa.
2007 © PATA

© Published online from South Africa.