QUOTE TB Light Sara Massaut Senior Project Officer

QUOTE TB Light Sara Massaut, Senior Project Officer, TB CAP/KNCV ACSM sub-working group meeting November 30 and December 1, 2009 Cancun, Mexico

Contents • Introduce QUOTETB Light—a patient centered approach • Experiences from the field (Nigeria) • Issues and the way forward

Background • Quality Of Care Through the Eyes of the Patient • Developed and piloted in Kenya, Malawi, Uganda Published 2007 • Collaboration between KNCV, KIT, NIVEL and RCQHC

QUOTE-TB • To measure performance of health services through the eyes of the patient weighted by what patients find important. • Experience showed that application was complex with a strict scientific and costly approach. • Develop QUOTE-TB Light

What is QUOTE TB Light? • More user-friendly application of the original QUOTE-TB • A “ready to use” package with standardized instruments for application • Pictogram cards to measure importance • Questionnaire to measure performance • Data entry worksheet to calculate Quality Impact

Quality Dimensions • • • Communication and Information Professional Competence Availability of services Patient provider interaction and counseling TB/HIV relationship Support Infrastructure Stigma Affordability

QUOTE TB-Light in three steps Step 1: Establish the Importance ranking score of nine quality dimensions that are important to patients (FGD). Step 2: Establish the Performance score for TB care as provided by the health facility (Individual Interviews) Step 3: Calculate the quality impact scores of the TB care. (Importance score X Performance score X 10)

Set up of Field test in Nigeria • Three weeks in with two teams: TB CAP, NTBLCP, State Supervisor and ILEP • 8 facilities—one per day—in four States. • 4 FGDs with average 8 patients each • 77 individual patient interviews to assess performance of health facilities

Results 1 Quality Dimensions and TB Care Services Affordability Importance Score Performance Score (% negative responses) Quality Impact >0. 75 61% No Pay for TB services 61% 0% 0. 0 No tip for TB services 61% 0% 0. 0 Professional Competence 83% Home based TB treatment 83% 65% 5. 4 Contact tracing 83% 61% 5. 0 Support 47% Support for transport 47% 100% 4. 7 Support for food 47% 100% 4. 7

Results 2 Quality Dimensions and TB Care Services Communication and Information Importance Score Performance Score (% negative responses) Quality Impact >0. 75 94% Drug side effects 94% 40% 3. 8 Stop spreading TB 94% 3. 2 Stigma 17% Stigmatizing communication 17% 5% 0. 09 Welcoming atmosphere 17% 3% 0. 04

Summary findings Nigeria • Health Education is a major issue to be addressed—informing about and understanding illness is essential. • Providing food and transport support is important to TB patients; what are feasible interventions for TB programs? • Stigma does not seem to be a big issue

Issues and Way Forward • Application during routine supervision vs OR approach? • Patients who do not come to the facility for care not included. • Translating results into interventions? • Patient involvement • District level vs national

Loose Ends • Introduction during Patient Centered Approach session on Dec 4 from 9 -12 at the Fiesta America Grand Coral Beach Hotel (Coral Gallery 1 C) • Send questions and experiences of use to Sara Massaut at massauts@kncvtbc. nl • www. tbcta. org

Acknowledgements Dr. Mansur Kabir, NTBLCP Jumoke Onazi, TB CAP Nigeria Emmy van der Grinten, TB CAP Nigeria Sani Useni, NLR Tolu Oguntimehin, TLM Abebayo Peters, NTBLCP Apanda Goje, Kaduna STBLCP TB Patients in Kaduna, Kwara, Bauchi and Abuja that particiapted in field testing Jacques van der Broek, KNCV Anke van der Kwaak, KIT Herman Sixma, NIVEL