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Monday, December 29, 2008

WHIVP Consulting trip to Capetown, South Africa: Act IVa

Act IVa: What we actually did in Capetown in 2 partsLink
Having to break down my story of Capetown into various acts makes me appreciate story telling even more. Act I set the stage, Act II were some of the better stories that emerged, and Act III was a tribute.

I also saved the what we did for the last Act since it mirrors what happens in development work. Peace Corps had learned that it takes 3 generations of volunteers in a community for effective development work.
  • The 1st volunteer introduces the community to Peace Corps, what Peace Corps can do and starts the personal relationship
  • The 2nd volunteer introduces new work projects and starts the work relationship
  • The 3rd volunteer gets the glory by finishing all the work
We were the 2nd generation of volunteers in Capetown and were starting the work relationship. To further underscore the importance of the relationship, Peace Corp's 3 official goals are 1) teaching the host country about the US, 2) learning about the host country and teaching the US upon return, 3) do work. 66% of Peace Corps is relationship building which is important to emphasize. Those relationships become the bedrock for future work.

Hence, I spent the first 3 Act talking about the relationship. But for those who are wondering what heck the ROI was on trip, here's what our 3 teams did:

Clinic Operations Improvement: My team was involved in Clinic Operations Improvement and we visited 5 clinics in a variety of townships. The photo on the right is of Khayelitsha, one of the larger townships. The township clinics felt understaffed for all the work but needed to demonstrate the need for additional resources and that they were using current resources as efficiently as possible. During our visits, we shadowed staff, patients, and timed various parts of the visit. Most patients came in the morning to ensure they could be seen. As a result, mornings were overwhelming and afternoons were quieter. An appointment schedule wouldn't work since most patients didn't have watches and culturally all were used to scheduling around blocks of the day like dawn, late morning, noon, etc. A solution was to block off these periods into appointment types like well baby visits would be in the morning (when mothers and children typically travel) while TB visits would be in the afternoon (when children would not be there). STD visits could be on one specific day when a specialized staff member could attend.

We also conducted work shops to teach the clinic managers how to do operations improvement in the future. The workshops were around Continuous Quality Improvement (CQI), performance management, using score cards for planning and evaluation, and a summary of findings. The clinic managers had never seen these hands on techniques before that while more standard in US health care, were not widely used in South Africa.

Our findings showed that adding more nurses (nurses were typically the highest clinical level), a frequent request from the clinic managers, wouldn't help see more patients since patients had to complete the registration process and visit with the medical assistants. The best solution was to ensure that everyone worked at the top of their license. The nurses would often do work that lesser trained staff could do such as weighing babies since that was their typical practice. With our observations across clinics as non-politically affiliated observers, we were able to help the clinic managers they saw that adding less expensive staff such as medical assistants or people at the registration desk would improve efficiency more at a lower cost.

A lot of our recommendations had been made by the previous group in the form of a report. They didn't have the time to do a the 4 days of work shops that we did but some of the clinic managers had tried their recommendations such as the block schedule and were successful. As you can imagine that endorsement convinced most of the clinic managers to try these new techniques.

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