Enabling knowledge and experience sharing among health care providers through multi-facility interaction

Delphina Ntangeki

Improvement Advisor, KM and Communications, Tanzania, USAID ASSIST Project/URC

In February 2015, the Partnership for HIV-Free Survival (PHFS) in Tanzania conducted the second PHFS National Learning Platform which took place in Mbeya Region. This was preceded by the first National Learning Platform conducted in April 2014 in Dar es Salaam. The National Learning Platform was planned as part of the quality improvement framework for PHFS that was designed by the Tanzanian PHFS National Steering Committee, under the global leadership of the USAID ASSIST Project.

In Tanzania, PHFS aims to increase coverage of antiretroviral (ARV) uptake by HIV-positive pregnant women, mothers and infants attending postnatal care at 10 sites each in Nzega (Tabora), Mufindi (Iringa) and Mbeya urban districts (Mbeya). This is being achieved through timely and correct ordering of ARVs and adherence counseling; increasing the proportion of mother-infant pairs retained in post-natal care through system strengthening, community involvement and improvement innovations; increasing the proportion of HIV-exposed infants and children up to 2 years of age who are confirmed of their HIV status through DNA/PCR or antibody testing and who are initiated on ARVs; and increasing the uptake of the Nutrition Assessment and Counseling Support (NACS) care package through system strengthening and provision of NACS tools and training of health care workers on NACS. 

A Visit to Mbeya Regional Hospital, Tanzania

Mbeya Urban district Nutritionist Coordinator (second left), explaining to PHFS National Learning Platform participants who visited Mbeya Regional Hospital about challenges the health care providers at the hospital face when filling nutrition information in the children register due to lack of the column for nutrition information in the register. Photo: Delphina Ntangeki, URC.

During the learning platforms, participants--including health care providers, community volunteers, Regional and Council Health Management Teams (R/CHMT) from the three implementation districts, implementing partners, donors and the Ministry of Health and Social Welfare (MOHSW)--gathered to share national level updates related to PHFS, experiences and progress. 

I was privileged to attend the two learning platforms in Dar es Salaam and Mbeya. I found them to be very significant as they brought together all stakeholders involved in implementing the initiative to discuss the progress of the initiative as well as agree on different ways of addressing challenges faced during the implementation process. I believe the platforms, at least the experiences that were shared in the first platform, have made huge contributions to the improvement the initiative has achieved so far.

This year’s learning platform was conducted in Mbeya Urban District so as to give opportunity to participants to visit PHFS implementation sites to learn, share knowledge and experiences on how different PHFS sites work to eliminate mother-to-child transmission of HIV. 

The first day of the learning platform was for site visits whereby participants were divided into 6 groups, and each group visited one site to learn and share experience on how the sites from the three districts applied quality improvement techniques to improve retention of mother-baby pairs, ARV uptake among lactating women, nutrition, community involvement and HIV early infant diagnosis (HEID) identification and testing. The groups then made presentations on what they found as strengths, suggested areas of improvement and major learning from the sites they visited.

My group visited Mbeya Regional Referral Hospital where we toured different service delivery areas, including the reproductive and child health clinic, labour ward, postnatal ward and option B+ room where we met with health care providers and discussed different PHFS activities implemented at the hospital. 

During the discussions, health care providers and community members from the three districts asked each other questions on how their sites implement PHFS activities, while sharing experiences on how they address challenges they face during the implementation process. For example, after every indicator that was presented by the health worker from Mbeya Hospital, all health workers discussed and asked questions regarding the indicator. The health workers from the sites which did not do well in the presented indicators asked for more information from the sites that did well, so as to try the same techniques to improve. In the areas where they both could not find solutions, they agreed to bring the issues to the bigger audience during the learning platform sessions, for a broader discussion. However, the health care providers were able to provide each other with a great amount of advice on how to comply with MOHSW guidelines as they implement the PHFS initiative.

After site visits, all participants gathered in the conference hall where they presented and discussed the learning from the sites. Different actors also responded to the questions raised by the group members that they found challenging during the discussions at the sites. Most participants expressed appreciation for the site visits and said that the site visit was the best part of the learning platform. “Next learning platform should take place in another district so that we could learn how other sites implementing PHFS activities… they are very important,” said a health care provider from Mbeya Urban.

The other two days of the learning platform were also interesting as the MOHSW presented national updates that affect the PHFS initiative, while implementing partners and the three implementing districts presented on the progress of PHFS activities in their respective areas. Stakeholders also agreed to scale up the PHFS activities to 60 more sites, 20 sites in each district. ASSIST shared the draft change package that was discussed during the learning platform and the tested changes that would be tried in the new sites were selected and agreed upon. These two days were even more interesting as most participants referred to observations from the site visits to comment on presented issues. This made the sessions more lively, as almost all participants at all levels--including those who have not visited the sites—left the platform with a clear idea of what was happening in the sites as far as PHFS initiative is concerned. 

Apart from the PHFS activities, health care workers also learned how to implement other activities in the facility, e.g., cleanness and organization of equipment in the service area. “…Wow! I like how their things are organized in their labor ward; and the area is very clean unlike ours,” whispered a health worker from Mufindi District when we were touring the labor ward.

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