TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

DATE OF ASSESSMENT

20/8/2014

SITE INFORMATION

Hai An 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: 1
Part-time: 6
Total: 7

Name

Position

Phuong

OPC chief,
doctor
Doctor
Nurse,
secretary
Counselor
Pharmacist
Peer, C&S
team

Huong
Truong,
Tho
Nhan
Hai
Roi

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

% total clients)
370 (28 Pre-ART/ 342 ART)

Contracted
Part-time
Full time
X

Gov
Part-time Full-time
X

X
x

X
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

71%

STRUCTURE AND
ACCESS

88%

DRUG SUPPLY

90%

LABORATORY
CAPACITY

90%

DATA MANAGEMENT

60%

CASE MANAGEMENT

33%

ART/Pre-ART
DELIVERY

50%

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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

30%

-37%

Fail

75%

67%

NA

#VALUE!

Pass

75%

90%

22%

22%

Fail

NA

#VALUE!

Pass

80%
85%

78%

82%

-2%

Fail

95%

84%

97%

10%

Pass

65%

87%

89%

51%

Pass

90%

38%

50%

-38%

Fail

80%

88%

100%

34%

Pass

85%

66%

20%

20%

Fail

85%

93%

93%

Pass

80%

68%

Fail

SMART monitoring score

SMART TA classification

Improving

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USAID/SMART TA

No

Issue

HUMAN RESOURCES
Dr. Phuong is Vice Director of Hai
An General Hospital and Hai An
OPC chief and ARV treatment
doctor and also a head of TB
department of the hospital so it is
difficult for her to be present at
the OPC to provide treatment
Dr. Huong is a part-time doctor
but she has been studying since
August 1, 2014.
Hai An hospital has proposed Dr.
Kinh, ex-director of Hai An general
hospital to be OPC chief and Dr.
Phuong to be a part-time
treatment doctor.
Doctors who have been trained
with Modules now is learning
others or doing other tasks so at
present there is no doctor who
has been trained with modules
can be a part-time doctor.
So the clinic is now lacking fully
qualified treatment doctor

1.

2.

Since the counselor has been on

maternity leave for one and a half
month, project secretary or
pharmacist or OPC chief has to
take the tasks of the counselor. It
negatively impact on counseling
and treatment quality of the clinic.

Supporter

Other
sources

Solution

Person in charge

Deadline

According to the orientation of

sustainable transferring of PEPFAR,
the human resources working for
the OPC will be gradually replaced
by the Government staff to ensure
the sustainability. Hai An OPC is
one of OPCs which implements
early sustainable orientation (Hai
An hospital has sent full-time staff
of the hospital to the HIV/AIDS
modules training to be a part-time
doctors in the OPC since 2013).
Based on Hai An General Hospitals
proposal, the sustainable
orientation of the donor and
PEPFAR and to ensure treatment
quality: The OPC chief must be the
Government staff so Dr. Phuong
will continue to be the OPC Chief.
Because the hospital lacks of
doctor, Dr. Kinh will temporarily
replace Dr. Huong to support Dr.
Phuong. However, Dr. Phuong has
to support Dr. Kinh until he can
join fully in all HIV/AIDS modules
according to the regulations of
MOH. Furthermore, the project
can sign a contract with Dr. Kinh to
be a part-time until December,
2014.

Director, Hai An
General Hospital

HP PAC

HP PHS
Coordinator

31/8/2014

Project secretary and C&S team

leader will take the task of
counselor.

Hai An OPC
Chief

C&S team
leader,
project
secretary

HP PHS
Coordinator

31/8/2014

Actual
date of
completio
n

Note

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USAID/SMART TA

3.

1.

2.

3.
C

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

TB Infection Control: Medical

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

IEC materials: Very few updated

IEC materials available including
updated job aids for staff to use
for patient counselling

DRUG SUPPLY
Some of fungal drug is not enough
for patients since the budget for
OI funded by the Life-gap project
is distributed based on the

Triage nurse should fill information

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

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
procedure, safe coughing
guidelines, nutrition for PLWH
- PAC to send the latest flipcharts
to Hai An OPC

PHS to adjust to reduce the bid

price for fungal drug and other OIs.
PHS to work with social and health
insurance department to add OI in

Triage nurse,
project secretary

Hai An OPC
Chief

HP PHS
Coordinator

Triage nurse,
counselor

OPC PAC

HP PHS
Coordinator

SMART TA, PAC

Hai An OPC

HP PHS
Coordinator

Hai An OPC,
Hai An GH

11/2014

Nov, 2014

October,
2014

11/2014

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USAID/SMART TA

number of patients in the OPC

while bid price set by PHS is very
high: 168.000/1 pill of
Fluconazole. The clinic has to
prescribe for the patient to buy by
themselves.
LABORATORY CAPACITY
Lab test department of the
hospital is taking blood sample for
CD4 and other regular tests twice
a week but it doesnt meet the
needs of patients.
DATA MANAGEMENT
Documentation: Three logbooks:
ART, pre-ART, daily medical checkup are updated. However, in the
Pre-ART logbook filled both preART patients and transfer-in
patients. The daily logbook has
coded the patients but it is not
appropriate with the reported
data. The number of transfer-out
ART patients is not appropriate
with the reported data of March,
2014.
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
logbooks so she didnt know how

the list of health insurance.

Hai An OPC to encourage and
support patients to buy health
insurance card.

Hai An GH to create favorable

conditions and manage the human
resources to enhance CD4 and
other regular test once a week.

Hai An GH

Hai An OPC

HP PHS
Coordinator

30/11/2014

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 Hai An OPC to verify data.

Triage nurse
Hai An OPC

HP PAC

HP PHS

Nov, 2014

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 Hai An 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.

Doctor and
triage nurse of
Hai An OPC

HP PAC

HP PHS

Nov, 2014

Triage nurse and

project secretary

Hai An OPC

Hai An OPC
Chief

Nov, 2014

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USAID/SMART TA

1.

2.

3.

to draw data from the logbooks to

report.
CASE MANAGEMENT
Doctor hasnt grouped patients
and appointed them for reexamination in group so patients
scattered come to the OPC. It
would be hard for the doctor to
know clearly who showed late or
stopped treatment. There is no
follow-up patients who come for
re-examination especially Pre-ART
patients.

Do not keep and record transferout patients so the OPC hasnt

follow-up and confirm the transfer
out.

Patient Follow-up: Follow-up of

referral cases, patients late reexamination, poor treatment
adherence must be improved.

OPC Chief to group patients in

batches based on the time of ARV
initiation for re-examination,
medication dispensing and tests. It
will help to reduce the burden for
the OPC.
Triage nurse to create a logbook to
follow-up the patients who late reexamination or stop treatment to
remind, then refer to the
counselor and C&S team to followup.

OPC Chief

Triage nurse to photo and keep

referral slip and call to confirm the
referral state.
Counselor to provide counseling
session to the patients before
referring.
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.

Triage nurse
Counselor

HP PAC

HP PHS
Coordinator

Nov, 2014

HP PAC

HP PHS
Coordinator

Nov, 2014

Triage nurse

OPC chief, Triage

nurse,
counselor,
Care and
support team

HP PAC staff

HP PHS
Coordinator

Nov, 2014

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4.
G

1.

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
- Hai An 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

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

Hai An OPC: OPC

Chief,
Receptionist,
Counselor, C&S

HP PAC

HP PHS

Nov, 2014

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USAID/SMART TA
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. In addition, the
family member of the patient take
medications for the patient so the
doctor doesnt know the health
status of the patient.

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
patients are eligible. Doctor has
stopped the Cotrim when
CD4250 according to the national
guideline and forget to continue
to prescribe Cotrim. Doctor
forgets to prescribe Cotrim as
soon as the CD4 test result <350.

Doctor prescribe INH for eligible

patients, especially for Pre-ART
patients.
Pharmacist to increase the
proposals of INH drug
INH is cheap so in case there is no
drug provided free of charge,
treatment doctor to ask the
patient to buy INH by him/herself
to ensure treatment adherence
and/or benefit from it.
SMART TA in coordination of HP
PHS to improve the coordination
mechanism between HIV OPC and
TB unit
Doctor to limit the fact that the
family member takes medications,
appoints more regular reexamination date for patients who
have problems on health status,
then take more time to explore the
disease history and TB treatment
to have more appropriate support.
Doctor to comply with guidelines
on prescribing Cotrim or Dapsone.
Triage nurse to check with CD4
results and remind the doctor.
Doctor to check patient chart,
especially patients who are eligible
for Cotrim prophylaxis for Cotrim
prescription.
HP PAC staff who is responsible for
HIVQUAL to check the data form to
make sure that the data is filled in
the form correctly

Doctor
Pharmacist

HP PAC

Doctor
SMART TA
HP PHS

PAC, and HP
TB program

Doctor
Triage nurse
Doctor

HP PHS

Nov,2014

HP PHS
coordinator

11/2014

HP PHS
coordinator
to check

Nov, 2014

HP PAC

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