Quality Improvement in a Tuberculosis Clinic in Chimbote, Peru

A comprehensive approach was implemented at the Yugoslavia Health Center (HC) aimed to improve quality of provision of tuberculosis (TB) services. This HCxs TB clinic was severely understaffed and disorganized, resulting in a low rate of identification of persons with respiratory symptoms and a high defaulter to treatment rate. Methods: After minor infrastructure improvements and assignment of additional staff to the TB clinic, the Standard-Based Management and Recognition (SBM-R) methodology was implemented to identify performance gaps and elaborate local improvement plans. These plans were designed to: (i) increase identification of persons with respiratory symptoms by educating communities through skits performed by HC staff; and (ii) reduce the defaulter to treatment rate by training peer educators and strengthening home visit programs. Methods for recognizing achievements will be determined and implemented in the near future. Results: Performance of the TB clinics was improved, lowering the performance gaps from 73% (June 2010) to 48% (January 2011). Simultaneously, identification of persons with respiratory symptoms rapidly increased from 2.2% to 4.76% in July and 5.05% in December 2010. The defaulters to treatment rate decreased from 18% during 2009 to 0 % during 2010. Conclusions: Performance improvement of a TB clinic could be rapidly achieved by a comprehensive approach, including infrastructure improvement, adequate staffing and use of the SBM-R.