Lugeye dispensary is providing the best example of using the community involvement in Quality Improvement. The Dispensary used the village meetings in distributed responsibilities for 10 sub-villages of Lugeye ward on fundraising required for construction of the modern dispensary with admission wards. In 2006 the dispensary renovated male ward, In 2009 female ward and PMTCT and OPD, 2014 paediatric ward, In 2014 x-ray room and 9 more staffs recruited through Magu Council strategy, AMREF and community contributions. From 2012 to 2014 a total of 8 new health care workers have been enrolled after setting targets for quality health care delivery by the council. The President of United Republic of Tanzania awarded an ambulance in January 2014. This environment has made the dispensary the unique role model for quality Improvement. URC-Assist and CSSC has described Lugeye Dispensary to be the best implementers of PMTCT Option B+ after >99% adherence of the developed quality improvement implementation plan through the use of 18 quality improvement indicators.

1. APPLYING QUALITY
IMPROVEMENT PRINCIPLES
FOR PMTCT OPTION B+: THE
BEST PRACTICE OF LUGEYE
DISPENSARY
4th National Quality Improvement Forum, NQIF
BOT Conference Centre
30th to 31st October, 2014
Salma Nasoro1, Elizabeth Biseku1, Magreth Nadila1, Hobhokela
Stephen2 , Jared Mussanga2 ,William Bendela3, Pastory
Sekule3, Moses Ringo3, Sarah Gaula3, Bernard Mbwele3
1. LUGEYE DISPENSARY
2. UNIVERSITY RESEACRH CO,. LLC. (URC)
3. CHRISTIAN SOCIAL SERVICES COMMISION (CSSC)

2. Background
 Lugeye Dispensary was established in 1958 with an honour
of Chief Sima Sumve for his people. Later on in 1967
Missionaries supported Health Service with three staff houses
and two toilets.
From 1958-1959, A temporary Dispensary of Lugeye Village was
having one rural medical assistance, Arobogast Mchele
 1964-167 there was one Medical Attendant, Andrew Mbio
 1968-1970 there was one Medical Attendant TBA Fredrick
Maga
 1970-1973 there was one who was Medical Assistant (MA)
from Sithuas Mwalimu
 After Arusha declaration in 1974 Lugeye dispensary was
over thrown by the government . It was having one medical
assistant doing everything for health care delivery.

3. Background
 Lugeye dispensary is handling a
range of 40 to 50 mothers for
reproductive and child health per day.
 A range of 70 to 80 patients for OPD
and an average of 20 patients for
inpatients per day.
 In 2005 when MCH services started
PMTCT with single dose Nevirapine,
the facility had 2 rooms and 3 health
care workers only for handling all
services.

4. PMTCT at Lugeye
 In 2009 Option B started,
 The facility presented with 64% of
incomplete of adherence of Zidovudine,
AZT from the 6th week to the end of
Pregnancy
 98% of mothers received Lamivudine
during labour
 However due to defaulters in AZT during
Pregnancy, 72.5% of mothers received
Nevirapine after delivery.
 In 2013, Option B+ started, with so many
Quality worried on retention of mothers
and outcome of infants.

6. Methods
 Village meetings in distributed responsibilities for
10 sub-villages of Lugeye ward on fundraising
required for construction of the modern
dispensary with admission wards.
 The facility was renovated in 2006 for male ward,
2009 female ward and PMTCT and OPD, 2014
paediatric ward, 2014 x-ray room and 9 more
staffs recruited through Magu Council strategy,
AMREF and community contributions.
 From 2012 to 2014 a total of 8 new health care
workers have been enrolled after setting targets
for quality health care delivery by the council.
The President of United Republic of Tanzania
awarded an ambulance in January 2014.

7. Methods…
 In October 2013, February 2014, 2
staffs out of 12 staffs from Lugeye
were trained for PMTCT option B+.
 In February 2014 and May 2014,
URC-Assist and CSSC developed
quality improvement implementation
plan through the use of 18 quality
improvement indicators that aimed at
testing all pregnant mothers and
breast feeding mothers (with their
spouses),

8. The Core QI indicators
 Proportion of mothers tested each month
 Proportion of mothers repeated testing each month
 Proportion of HIV positive mothers enrolled to ART
each month
 Proportion of exposed infants received Nevirapine
syrup each month
 Proportion of exposed infants with DNA PCR Sample
taken each month
 Proportion of exposed infants with DNA PCR Results
given to exposed infants each month
 Proportion of HIV positive infants enrolled to ART each
month
 Proportion of HIV positive Mothers enrolled for care and
treatment who have been retained each month

9. Results
Currently the dispensary has 6 Buildings
and13 staffs implementing the services
for Male ward, Female ward, labor ward,
Pediatric ward, Postnatal ward, PMCTC,
Outpatient care, Medical record
reception, Laboratory, Vaccination room
and Dispensing rooms.

11. A dispensary with Ambulance

12. Results…
From October 2013 to September 2014
the facility found the case for Option B+
in December 2013.
Among 430 mothers attended for
antenatal care, 399 antenatal mothers
were tested (92.7%) and 32 breast
feeding mothers who missed HTC
during their pregnancy from January
2013 to September 2013 were tested in
January 2014 to June 2014.

13. Results…
 By August 2014, Cumulatively 30 mothers were
on TLE (100%) for OPTION B+ (3 transferred
out, 27 are attending at Lugeye).
 Yearly registered exposed infants were 21 all of
them received Nevirapine (100%), all tested for
DNA PCR (100%).
 19 infants’ Mothers received status of DBS
(90.5%), (100%)18 got negative results and 1
sample was rejected and 2 samples were just
been sent July.
 DBS testing kits were available for 6 months only,
HIV rapid Tests were available for 10 months of
the year.
 From August 2013 to August 2014, Outcome
revealed 16 Babies survived, 2 transferred out, 3
babies died all with negative results

14. Discussion
 Community Mobilization motivated many
donors to support Health Care Delivery
 Staff commitment in following QI
indicator supported good outcome of
care.
 The availability of infrastructure was a
key contributor of success of quality
improvement.
The dispensary is working on the
construction of incinerator , expect to
upgrade to health centre.

15. Conclusion
 Commitment of district council and the
contributions from villages plays great
role in the set up of better health care
infrastructure, staff mobilization and
hence quality improvement.

16. Acknowledgement
 “Diwani” Destery Kiswaga from Magu District
Council for his influence in the community
 The people of Lugeye for their contribution and
commitments
 We acknowledge the QI support of Dr Bernard
Mbwele from CSSC for showing the way
 Dr Hobhokela Stephen from URC Assist Project
for guidance of QI indicators
 Monitoring and Evaluation Team of CSSC led by
Sarah Gaula
 CHMT members of Magu District (DMO, DACC,
DRCHCo)
 CSSC and their USG funding support

17. Wabheja Sana Ahsante Sana
Thank you very Much
Ndagha Fijho