Change being tested | The specific problem being addressed | Change tested and the no of sites that implemented the change. | How exactly was change tested (where, who, how, when, resources required, etc)? |
Following up on caregivers of children in OTC who miss their appointment dates | The caregivers miss appointments for a refill of RUTF due to long distance to the health facility or children falling sick and taken for care to a different health centre. | Assigned VHTs in each village to follow-up with caregivers of children in OTC who miss their appointment dates for a refill of RUTF within 5 days. No of sites tested and implemented the change: 5 | QITs generated a list of all children in the OTC whose caregivers missed their appointment date for refilling RUTF. Grouped the list of children in OTC whose caregivers missed the appointment by the village and tagged them to VHTs in the respective villages for follow-up. |
Sites had mobile communities, as a result, the mothers of children in the OTC often moved to other locations, thus causing them to miss the appointment dates for the refill of RUTF. | Refilled RUTF for 2 weeks for children whose caregivers were termed as ‘mobile communities’. No of sites tested and implemented the change: 4 | During health talk sessions, the QITs encouraged caregivers to let the service provider know if they plan to relocate to another community. Health workers assessed the children’s adherence to RUTF; if good, the caregiver was given RUTF for 2 weeks. | |
Caregivers have multiple and competing tasks to perform at their homes, causing them to fail to honour the appointment dates for refilling RUTF. | Conduct integrated EPI/EMTCT/ANC/Nutrition outreaches. No of sites tested and implemented the change: 3 | Incorporate a multi-disciplinary team to go for outreaches so that eMTCT/ANC and Nutrition services are offered during the outreach sessions. | |
Improving client adherence to RUTF | Caregivers failed to feed the children with SAM per RUTF protocol. Occasionally, children brought the malnourished child to the OTC site for a refill, as a result the instruction given on how to use the RUTF was forgotten. | QITs assigned VHTs and local leaders to monitor the administration of RUTF to children with SAM at home. Involved other family supporters and male partners in the care plan for children with SAM. No of sites tested and implemented the change: 6 | Assessed the adherence of the children identified during refill days. Offered supportive counselling to the caregivers QITs involved VHTs and local leaders in community dialogue meetings to monitor administration conditions at which the RUTF is kept at home, including the hygiene at the point of giving the product to the child. |
Improve clinical assessment of severely malnourished children | The team noted that there was oversight of appreciating a thorough clinical assessment of malnourished children during refill days. | Assigned a Nutrition focal person to take the lead in monitoring all services offered to children with SAM, from triage up to dispensary. No of sites tested and implemented the change: 2 | All children under the OTC programme were assessed for medical conditions at triage. If found sick, investigations are done. The client is reviewed by the clinician and treated promptly. The client is then refilled their RUTF |
ANC, Antenatal Care; eMTCT, elimination of mother to child transmission of HIV; EPI, Expanded Program on Immunization; OTC, outpatient therapeutic care; QITs, quality improvement teams; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition.