Delivery of High Quality Care —The SIMS Story
To ensure our HIV and TB implementing partners deliver high quality HIV services, PEPFAR developed the Site Improvement through Monitoring System (SIMS). Delivered through a standardized tool, SIMS site visits consist of a rapid assessment of services provided at CDC-funded health facilities. Using a 4-color scoring criteria (red, yellow, light green and dark green), SIMS visits examine core components of service delivery for HIV-infected patients. Through the efforts of SIMS, CDC Kenya is better positioned to:
- Make necessary shifts to inform the country operational plan,
- Monitor service delivery sites in all program areas,
- Use data and quality-assurance outcomes to improve services, and
- Recognize successes and share best practices among partners.
In addition to the benefits offered to CDC Kenya and its ability to support HIV programs, SIMS has also led to tangible and sustainable changes that positively affect facilities’ delivery of care. Some examples of substantive changes include:
Physical modifications in sites’ systems. One specific example of positive change can be observed in the improvements made to sites’ waste disposal system. SIMS visits revealed that biomedical waste was often deposited in a large pit on the facility grounds. Due to feedback received from SIMS visits and with support from implementing partners, sites developed proper waste disposal systems including the installation of incinerators. This not only met national standards, but created a safer environment for staff, patients and the surrounding community.
Staff adherence to guidelines. SIMS is always seeking to be in lock-step with the evolving changes made to standards of care. Chart reviews, for example, gauge the extent to which the provision of care meets the latest guidelines. On-the-spot training is offered to facility staff when current treatment protocols are not reflected in patient records, leading to increased adherence to guidelines by service providers.
County government engagement. CDC’s implementing partners are also charged with helping county government strengthen their capacity to eventually take on the lead role of supporting HIV facility services. SIMS creates a forum for ensuring that county engagement with CDC partners is ongoing, reflective of joint planning and leading to a period of transition from CDC-supported sites to county-supported sites.
As a constructive and systematic process, SIMS forms a platform for strengthening both human resources and the delivery of standardized guidance to address gaps. CDC Kenya is contributing to not only the provision of care, but the processes that lead to sustainable health systems strengthening.