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Root Cause Analysis of Low Performance in Percentage of TB Notified Cases with Universal Drug Susceptibility Testing Done  

Low performance means Universal Drug Susceptibility Testing (UDST) is not done for the notified TB patients as desired.

At the TB Unit (TU) level, obtain the list of patients not offered UDST from Ni-kshay. Write against each patient why UDST is not offered. Analyse the reasons.  

  • Who is not offered UDST (Person analysis)? - Are these patients from the public sector or private sector or both?  
  • Are there specific geographies where the problems are more (Place analysis)? - Is the issue bigger in a particular TU/ Peripheral Health Institute (PHI) or is the pattern the same throughout the district?
  • Is the low performance specific to any time period (Time analysis)? - Is the performance the same throughout the year or was it different in a particular time period?

Once this is figured out, try to explore the specific reasons for the observations.

Step-by-step processes which lead to low performance is to be analysed.

 

For the indicator the key processes are:

a) Patient referral for testing

b) Availability of specimens for testing

c) Specimen reaching the testing facility

d) Testing the specimen

e) Entering the report in Ni-kshay.

 

Explore the processes to answer the specific observations obtained during the initial analysis.

Keep on asking questions at each step to get an answer to why is that so. 

Discussion with beneficiaries and health providers, and verification of source records would provide more insight to the underlying cause.

 

A few possible causes and suggested solutions are given below.

Possible Causes

 Suggested Solution

Poor referral from the provider (public or private)

Plan for provider-oriented communication, sensitisation, and capacity building of the providers

Difficulty in extracting extrapulmonary specimens/ specimens other than sputum

Linkages with facilities for specimen extraction/ train providers for extracting specimens

Issues in the transportation of the specimen to the testing centre

Arrange facilities for specimen collection and transportation (Hub & spoke model)

Lack of testing facilities

Explore the possibility to set up Nucleic Acid Amplification Testing (NAAT) facilities/ starting in the private sector through partnership schemes 

Disruption of supply chain

Identify the cause and take steps to resolve the same and explore the possibility to outsource the testing till the supply chain resumes

Incomplete data entry in Ni-kshay

Proper monitoring/ training of staff/ sorting out internet issues etc.

 

 

 

 

 

 

 

 

 

                                                     

                                                      

 

             

 

                     

 

 

 

 

 

 

Note: This page describes only an approach for analysis of low performance and has not captured the entire list of problems or solutions. The root cause analysis may be modified according to the local context.

 

Resources

 

Assessment

Question​

Option 1​

Option 2

Option 3

Option 4

Correct answer​

Correct explanation​

Page id​

Part of Pre-test​

Part of Post-test​

Select the probable reason for low performance in the percentage of notified cases with UDST done.

Poor provider referral

Lack of testing facility

Lack of specimen transportation facility 

All the above

 4

Poor provider referral, lack of testing facility and lack of specimen transportation facility may contribute to low performance in the percentage of notified cases with UDST done.

 

 

 

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