The Quality of Care Management Center in Nepal: Improving Services with Limited Services
Case Studies 1-3

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Case Study 1:
Meeting Training Needs

Makawanpur was one of the first district family planning service centers to receive a QOCMC supervision visit. At the end of the visit, training needs were discussed with the clinic staff. One provider had become disillusioned because his requests for training had been repeatedly ignored in the past. He was rude and uncooperative when QOCMC staff invited him to discuss his needs. He brought out a package of letters written over the years to the central office requesting training, all to no avail. The district health officer confirmed that this staff member had been providing services for a long time without any training. Although QOCMC staff assured the man that he would receive the proper training, the disillusioned provider remained unconvinced and pessimistic. Center staff then approached the National Health Training Center and discussed the training needs of the Makawanpur staff member. Within two weeks, he received a letter notifying him of his placement in a training course. Since receiving this training, this staff member has proven to be one of the most effective and valued providers in the government system. The Family Health Division has recognized him for his excellent work, and he now collaborates closely with QOCMC staff.

Case Study 2:
Why Instruments Malfunction

At one site, the doctor complained that the forceps at the clinic did not tightly grasp tissue. Upon examining the instrument, the supervisor and staff found dried blood in the grooves at the tip. They also found that the staff member responsible for cleaning the instruments was required to go assist the same doctor at another site as soon as the clinic closed. Because she did not have time to clean instruments before leaving, she left them to be cleaned later. The blood and other bodily fluids on the instruments dried, making it more difficult to clean them later, and often all of the dried blood was not removed before autoclaving. Over time, dried blood built up on the instruments, and they did not work properly. Despite the fact that the worker responsible for cleaning knew the appropriate procedure, she was unable to follow it because of problems with time management. Solving the problem required changes in the worker’s schedule and discussions with her superior. This case illustrates the importance of handling site-specific problems and the need to address both management and technical issues.

Case Study 3:
Expanding Services

Nawalparasi is one of the districts in which the government is working to provide a range of family planning methods throughout the year. To help achieve that goal, the government built a new building, provided equipment and supplies, and trained providers to insert Norplant implants and IUDs. When QOCMC staff first visited, the new building was being used to store vaccines and equipment. Only pills, Depo-Provera, and condoms were being distributed. Clinic staff had never been oriented to the new services. They did not know how to organize the workplace and their activities to offer a range of methods or what management and logistical support would be required. With regular support, encouragement, and visits from the QOCMC, the district center is now offering a range of temporary methods, including Norplant and IUDs, and is searching for a trained physician so it can also provide sterilization services.