Maximizing Resources Where Resources are Limited: a Rural Health Facility's Efforts to Improve Storage of HIV Records in Uganda
"In November 2009 we started seeing a surge in the number of patients coming to receive HIV care services at our facility, resulting from a campaign initiated by Bukedea district to test people for HIV. By January 2010 we had registered over 240 patients in care, and it was such a difficult task keeping all their HIV care cards bundled up in one corner of the room in no particular order. We requested the Ministry of Health (MoH) officials and the Bukedea District Office for file cabins so we can store patients' files safely and in an orderly manner. By January 2011, we were still waiting fot the file cabins."
That was the situation as narrated by Mr. Stephen Okiror, the leader of the Quality Improvement (QI) team and in-charge of the HIV care clinic at Bukedea Health Center (HC) IV in Eastern Uganda. By February 2011, the clinic had 328 patients enrolled for care, and each had a patient file. Retrieval of files on clinic days was difficult, with many patients waiting for more than 20 minutes for their files to be retrieved, and sometimes these files could not be found.
Instead of continuing to wait upon the MoH or any sympathetic partner to provide them with means of orderly storing their patient files, the facility QI team identified an un-used resource: empty boxes in which the therapeutic foods had been supplied by NuLife, a sister project to the USAID Health Care Improvement (HCI) project (both managed by the University Research Co., LLC).
Utilizing lessons learned from the support received under the USAID Health Care Improvement project's interventions to improve HIV records and data management, the health facility team had started sorting out patient files and arranging them in accordance with scheduled clinic appointments. However, due to lack of adequate space within the one-roomed clinic, the files would be arranged and stored in one corner of the room. From there, they would still get mixed up delaying retrieval on clinic days. In May 2010, the facility started receiving nutritional support from the USAID-supported NuLife project that provides therapeutic food for malnourished HIV patients. These foods are supplied in large strong boxes, which are rendered useless once emptied.
"During one of the clinic team meetings in which we review the quality of care" continued Mr. Okiror, "one of the nurse mid-wives suggested we could use the empty boxes to store patient files. It sounded like a good idea but one we had never though about. So we decided to try it".
Initially, unfortunately, the boxes did not work well. Even though the patient files were clearly labeled, the boxes were not and so files could get mixed up. In the subsequent team meetings after on-site coaching from HCI, the QI team decided to label the boxes as per the HIV clinic days, which were Tuesdays and Thursdays of each.
"I expect 21 pateints next Tuesday since it is the 1st Tuesday of the month. And if they do not come, I will know the number and names of those who have missed their appointments by looking at the files that were not picked. The ability to improve our HIV care through application of our ideas, and use of available resources gives the team great satisfaction", concluded the records' assistant at the facility, Mr. Patrick Ejiet. He also observed that any patient currently waits for less than 5 minutes before their file is retrived, a significant improvement when compared to a 20-minute wait in the past.
The lack of proper storage facilities for HIV patient files is a common occurrence across the over 400 health facilities providing HIV care and ART services to over 470,000 patients in Uganda. This problem affects clinic efficiency, as it results in patients waiting longer to receive care and clinics ending late. However, if such no-cost but high impact ideas like use of emptied boxes as applied in Bukedea HC IV are utilized, significant improvements in client waiting times and tracking of active patients can be observed.