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Streamlining Client Flow Systems at Public Healthcare Facilities to Integrate HIV Testing and Counselling

For Regional Referral and General Hospitals, which continue to experience large client numbers in HIV clinics, effective client flow systems will further improve the quality and efficiency of services. In close partnership with Ministry of Health (MOH), the USAID Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) program strengthens healthcare service provider skills through training, mentoring/coaching and support supervision for quality HIV service delivery. The Provider-Initiated HIV Testing and Counseling (PITC) approach to HIV Testing and Counselling (HTC) is one of the approaches that hospitals supported by the program have integrated into routine healthcare service delivery and is taking root.

In July 2013, a team from USAID/SUSTAIN program partnered with the MOH to facilitate hospital teams at Jinja RRH in identifying problems that contributed to low HTC in the Out-patient Department (OPD) despite the high demand for the services. The five-day mentoring and coaching exercise enabled the hospital OPD team to define challenges affecting HTC and propose solutions. Some of the challenges identified included poor client flow, lack of role clarity among team members and lack of proper directions to access the HTC room, which resulted in clients getting lost.

The mentorship team therefore facilitated the healthcare team at OPD to come up with priority interventions aimed at increasing uptake of HTC. The teams revised the client flow at OPD, integrating HTC in the continuum of care before client consultations with the clinicians. As a result, the new client flow chart was developed to start with triage, followed by client education, HTC and consultations with the clinicians. Depending on clinicians’ assessment, clients would then be referred to the laboratory for more tests or the pharmacy to receive appropriate medicine. At the OPD triage point, the client flow chart was displayed to reinforce verbal directions routinely given to clients to access OPD services. The OPD team also allocated tasks among themselves on who would offer health education, counseling or testing services to the clients. The team reached consensus to adopt the new client flow system because it improved uptake of HTC services. Clinicians found the idea of conducting HTC before interaction with clients helpful in diagnosing client illness/conditions. Healthcare workers post a re-designed client flow chart at the Out-patient Department of Jinja Hospital

It is much easier to establish a client’s illness if I know their HIV status. For those whose status is positive, we provide additional counseling and encourage them to continue/start on medication,” reported Gorret Kirumira, a clinician at Jinja Hospital OPD.

For the quarter from July‒September 2013, Jinja Hospital achieved 105.3 percent of their OPD target (12,832 clients tested, counseled and received their test results), documenting a 32 percent increase than the previous quarter (April‒June) where 9,717 clients were tested, counseled and received results.

Healthcare workers post a re-designed client flow chart at the Out-patient Department of Jinja Hospital

Jinja Hospital is one of the 16 hospitals supported by the USAID/SUSTAIN program which has integrated PITC in routine healthcare package to increase HTC uptake and accessibility.


Written by; Rosemary Nasaba, HTC Program Advisor, Kellen Baguma, HTC Program Officer, Julian Natukunda, Communications Specialist with contributions from Jessica Ziegler, Knowledge Management Specialist at URC