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Root Cause Analysis (RCA) for Low Performance in Percentage of TB Notified Patients with Known HIV Status

Low performance in the indicator means that the notified TB cases are not getting HIV tests done as desired.

Analyse the Ni-kshay data and try to gain more insights into the problem. Some examples are given below.

The key questions are

  • Who is not knowing the status (Person analysis)? – Are the patients from the public sector or private sector or both? Is it any specific age group (e.g. paediatric) or gender?
  • Are there specific geographies where the problems are more (Place analysis)? - Is the issue bigger in a particular TB Unit (TU)/ Peripheral Health Institute (PHI) or is the pattern the same throughout the district?
  • Is the low performance specific to any time period (Time analysis)? - Is the performance the same throughout the year or was it different in a particular time period?

Once this is figured out, try to explore the specific reasons for the observations. For that, step-by-step processes that lead to low performance need to be analysed.

 

For the indicator, the key processes are:

(1) Referral for HIV testing by the provider

(2) Patient reach Integrated Counselling and Testing Centres (lCTCs)

(3) Performing an HIV test at the laboratory

(4) Entering the results in Ni-kshay. Ask the above three questions at each process level. Keep on asking questions at each step to get an answer to why is that so.

Discussion with beneficiaries and health providers, and verification of source records would be helpful.

 

Some of the possible causes and suggested solutions are listed below.

Possible causes Suggested solutions
Poor referral from a provider Plan for provider-oriented communication, sensitisation and capacity-building of the providers
Patient resistance Arrange facilities for proper patient counselling/ training of staff on counselling/ using peers for effective counselling
Resistance  to testing in a particular group in the community Plan targeted advocacy & communication activities
Lack of testing facility Take steps to set up co-located ICTC/ linked ICTC at the TB detection centre. If the issue is specific to patients notified from the private sector, take steps for linking private health facilities to ICTC or explore the possibility to set up an ICTC/ linked ICTC in private health facilities through the Public Private Partnership (PPP) model
Lack of Human Resources (HR) Take steps to provide adequate HR/ optimise available HR through redistribution/ train available HR
Poor data entry in Ni-kshay Measures such as proper monitoring/ training of staff/ sorting out internet issues etc.
Disruption of supply chain Take steps to resolve the same
Less testing specific to any age group, e.g., paediatric age group Take measures to sensitise the paediatricians

 

Note: This page describes only an approach for analysis of low performance and has not captured the entire list of problems or solutions. The root cause analysis may be modified according to the local context.

 

Resources

 

Assessment

Question​

Option 1​

Option 2

Option 3

Option 4

Correct answer​

Correct explanation​

Page id​

Part of Pre-test​

Part of Post-test​

What is the possible cause for the low performance of the indicator- Percentage TB notified with known HIV status?

Poor referral to ICTC

Lack of testing facility

Data entered in Ni-kshay  

All the above

 4

Poor referral to ICTC, lack of testing facility and data entered in Ni-kshay may all contribute to the low performance of the indicator - Performance TB notified with known HIV status.

 

 

 

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