Background
Overview of BIMI
Steps in the job aid | Indicated actions |
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Step 1: Ask caregiver for child’s age | Mark age up to 5 years old |
Step 2: Ask caregiver about child’s symptoms | Mark cough, diarrhoea and/or fever If cough present, check for fast breathing |
Step 3: Ask caregiver and look for danger signs | If any danger signs present, refer to local health centre |
Step 4a: Pre-referral treatment if danger signs | Give ORS, amoxicillin, ACT, or rectal artesunate depending on the danger sign(s) present |
Step 4b: Treat and advise if no danger signs | For cough, give amoxicillin For diarrhoea, give ORS and zinc For fever, give ACT |
Step 5: Advise for all children treated at home | Give more fluids Go to health centre if notice danger signs Sleep under bed net Follow up with VHW in 3 days |
Step 6: Advise on routine care of newborns | Keep baby warm Exclusive breastfeeding Skin and cord cleanliness |
Overview of the BIMI referral system
Methods
Evaluation aim | Quantitative indicator | Data source |
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Describe the iCCM referral system | Total number of children referred | Monthly reports |
Number and location of referral forms found at BHC | Referral forms | |
Ascertain the degree of patient compliance with referrals | Number of referral forms found at BHC | Referral forms |
Number of referred patients found in the 2014 BHC registers | 2014 sick patient registers; 2014 IPD and OPD registers |
Data sources and analysis
Results
2014 referral system in Bugoye
Discussion
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Referred patients may not bring the referral form to BHC;
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Referred patients may go to another health facility or drug shop for their referral;
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Referral forms may be misplaced at BHC;
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Patient names may not be recorded in the BHC registers.
Conclusions
Identified M&E challenges | Proposed solutions |
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Inadequate tracking of referral forms | Standard filing system for referral forms agreed upon by health centre staff Weekly collection of referral forms by staff to further ensure secure storage Periodic trainings with health centre staff and VHWs to review referral and data collection protocols Mobile health applications [22] including text message reminders or real-time documentation of referral placement and completion via mobile devices |
Discordance between multiple data sources | Unique patient identifiers to simplify monitoring across data sources [23] Continued triangulation of multiple data sources, as seen in this study among others [8] |
Inconsistent monitoring and evaluation of the referral system | Referral indicators in the monthly M&E report Monthly dashboard to compare multiple data sources Community-based quality improvement approaches, whereby health care workers receive regular feedback from M&E data collection and are actively involved in subsequent programmatic decision making [24] |