SUCCESS STORY: MOTJANE CLINIC TAKE OWNERSHIP OF CMIS
Health facilities in Swaziland have been utilizing a multi-layered paper-based system that employs registers and record cards, with some largely stand-alone computerised record keeping in the Anti-Retroviral Treatment (ART) programme. This has resulted in a number of issues in the accuracy, breadth, depth and speed of data capture across the health sector.
In efforts to improve the quality of provision that health service clients (patients and users of health services) receive on each visit to a health facility, a single client record template, has been introduced and implemented to replace the current array of separate programme registers and card systems called Client Management Information System (CMIS). The system is being implemented across all Swazi government and partner organisation’s health facilities.
Through the USAID/PEPFAR funding, IHM Southern Africa along with the Ministry of Health and other implementing partners have undertaken a project to transform 134 health facilities in Swaziland through the use of CMIS which is client-based as opposed to the case-based system which was previously being utilized. The purpose of this system is securely and accurately store a patient’s health records in one depository which is accessible to clinicians in any facility where the system is installed.
Spotlight on Motjane Clinic
Currently there are 20 facilities which are fully live on CMIS, and Motjane Clinic located in the Hhohho region of Swaziland has taken great strides in implementing the system, and owning it as a facility. Head Nurse, Sister Nokufika Chirwa explained how filling in paperwork was such a cumbersome and tiresome task when having to attend to as many as 80 clients on busy days. She made an example of a client utilizing the Out Patient Department (OPD), the nurse will fill in their OPD card, and then fill in their details in the register with the client’s diagnosis. Thereafter, the nurse will complete the tally sheet capturing their demographical information which are consolidated on a daily basis.
The nurses would find themselves skipping some of the processes involved in filling out paperwork in the effort to reduce long queues and provide the service needed by the patients. This resulted in the facility performing poorly at Regional Semi-Annual Reviews (RESAR).
CMIS went live in the Motjane Clinic in September 2016, and the clinicians were greatly pleased with the ease in which they were able to perform their tasks. Prior to attaining the “Go-Live” status, all of the nurses were taken through an extensive training on CMIS. They went on further to do in-site practice runs. All the service points at Motjane Clinic are utilizing the CMIS system, and have forgone the utilization of registers.
Sister Chirwa credits teamwork and a positive attitude as major contributing factor to the successful implementation of CMIS at Motjane Clinic. The facility has embraced and owned CMIS to the point that they have introduced what they have coined the “Supermarket Approach”.
The Supermarket Approach
If a client visits the facility to receive health services, they can be assisted at any of the service points. This approach was taken to improve service delivery. If a client has come in with the Flu yet would also like to access family planning services, the nurse in OPD can provide both services through the system. Previously, a client would have to go to both OPD and Family Planning for these services. The team have truly taken the system and ran with it in their facility. Motjane has set the bar for other clinics who are gearing up to go-live the system that transforming to paperless health can be done through teamwork and ownership of CMIS.
Since “going-live” in September 2016, Motjane Clinic has registered 6347 clients onto CMIS, with more clients being registered every day.
“I remember a point in time when we had just started using CMIS in the facility, there were long queues as we were still getting accustomed to the system. There were talks among the nurses of going back to using the paper-system to alleviate the queues. I told my team that we are not going back, we are moving forward. On the first day of “Go-Live” I told my team that I am not using any paper, not even a pen!”
– Nokufika Chirwa, Nurse, Motjane Clinic.