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The largest expenditures associated with SBM-R were for facility action plans to improve services, notably the purchase of supplies and equipment and ART training.
A quality improvement initiative that included multiple reinforcing activities including provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, facility action plans, and task shifting succeeded in raising the quality of PMTCT services at ZDF facilities.
Future rounds of SBM-R could have an even greater impact by shortening the SBM-R tools so that they are more narrowly focused on PMTCT and can be used for provider self-assessments; ensuring that facility action plans address provider performance as well as facility readiness and management issues; and deploying lay workers in the community to encourage pregnant women to seek ANC earlier.
They observed consultations, mentored and coached providers on service delivery to meet the detailed verification criteria of the SBM-R standards, and reviewed and revised the facility's action plan together with the local team.
None of the violations was severe enough to warrant financial penalties, according to the Department of State Health Services, which deemed the facilities' corrective action plans sufficient to protect patients.
ESRD Network staff members will provide assistance and review of facility-specific action plans.
The approach included mutually reinforcing activities: (1) training, (2) supportive supervision, (3) assessments of service quality, and (4) facility-based action plans.
Dialysis facility-specific action plans to reduce disparities and to improve access to kidney transplant referrals will be a required component of this multicomponent intervention.
The SBM-R teams and managers at all of the facilities considered implementing the action plan to be the most important part of SBM-R and worked at it daily.
A team of managers and health workers use SBM-R tools to identify and analyze weaknesses in service provision at their own facility and to develop an action plan to address them.
A multi-factorial individualised (to the specific requirements of each facility) approach will be used to develop and implement an action plan in each participating facility based on the best available evidence.
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