Clinical Indicators in Primary Care – Why Do They Matter? PCI Reports from Rwanda

For the past year, PCI’s Healthcare Innovation Programme (HIP), in partnership with Letshego, has been working with Health Builders in Rwanda.  Health Builders support primary care health centres by providing mentorship and supervision in five key management areas which include HR, finance, pharmacy logistics, IT and infrastructure.

Health Builders have now developed a supervision tool to support a sixth management area – quality of clinical management. During 12 months of careful development, this tool has now been tested in 14 health centres with mentoring delivered in 5 of them. Importantly, the tool includes indicators for Non-Communicable Diseases, which are very often less well understood in primary care. What’s more, by adopting an agreed set of standardised clinical indicators, the tool will enable the capturing of consistent data across clinics and provide measurable evidence of impact.

In January, Karen Bevan-Mogg (one of PCI’s clinicians) visited Kigali to see the supervision tool in action and catch up with the Health Builders team, after working with them remotely. It was also an opportunity to hear more about how the clinical supervision tool continues to evolve and to address learning needs the team identified around leadership and communication both for themselves and for the health centre staff they support.

Karen devised a 2-day workshop for nine members of staff from management and clinical teams who participated with huge enthusiasm and dedication. They participated in discussions and group exercises to consider current team dynamics and communication and potential alternatives which might motivate and encourage change. The clinicians also refreshed their consultation skills and had a go at producing health education videos – including the first-ever instruction video in KinyaRwandan on ‘How to Use an Asthma Inhaler’.

It is well known, and often quoted, that a strong primary health care system is the foundation for good NCD care – and that this is missing, or difficult to achieve, in many countries. What this project seeks to demonstrate is how strong, well-managed primary health care delivery can bring real, measurable improvements in NCD care. Testing this assumption through the work of Health Builders adds a valuable dimension to the portfolio of practical innovations that the HIP seeks to support.

The tool now needs to be applied consistently over time, with simple indicators measured to see whether health centres with clinical management support do in fact increase their capacity to deliver measurable improvements in NCD care.

This project has strategic significance as the Rwandan Ministry of Health rolls out the decentralization of NCD care from hospital level to health centre level – a process which should be complete by June 2018. As they deal with the growing influx of NCD patients moving over from hospital care, Health Builders has an important role to play, alongside the Ministry of Health directives and training courses, by supporting the health centre teams to carry out their new responsibilities for NCD care effectively.

As Karen concludes: ‘Now that Health Builders has ensured that data collection systems and protocols are in place, we will be looking to see stability of clinical indicators as NCD patients are transferred from hospital care to health centres. We hope to demonstrate that decentralized care by the health centre continues to be effective.’