In October 2016, USAID/Nigeria awarded DevTech the Support for Strategic Information and Project Management Services (S4SIPMS) project in support of the HIV/AIDS, Tuberculosis (TB) Program in Nigeria. The project, which came to a close in 2021, was part of the Office of the Global AIDS Coordinator-led President’s Emergency Plan for AIDS Relief (PEPFAR), which seeks to make strategic investments in quality programming that yields greater impact on saving lives and improving the health status of people living with HIV.
As part of its efforts to combat HIV/AIDS in Nigeria, the Mission team tasked DevTech with supporting the strengthening of the Nigerian national health system through the use of Site Improvement through Monitoring Systems (SIMS). SIMS continuously monitored and assessed sites receiving PEPFAR funding to ensure effective quality program implementation, and the adherence to national and international standards and accountability.
The four-year S4SIPMS project required that the DevTech team:
- Plan and conduct SIMS assessments, including by providing support for all data collection, analysis, reporting and quality improvement needs through the use of the SIMS tools.
- Increase the capacity of implementing partners (IPs) and strengthen the Mission’s capacity to utilize SIMS data for continuous quality improvement and program monitoring.
- Provide knowledge management support ensuring that health facilities have access to and use data to support sustainable program and service delivery improvement.
Through S4SIPMS, the DevTech team:
- Met or exceeded its assessment targets across all five years of the program. In fiscal year 2017 and 2018 alone, the team conducted 1,119 SIMS assessments exceeding the total 2017 and 2018 targets by 113 assessments. Many of these assessments were conducted in highly volatile conflict zones; at the time, DevTech was the only contractor with the on-the-ground capability to do so on behalf of the U.S. Government.
- DevTech’s S4SIPMS team achieved these results despite COVID-19 safety and logistical challenges, and a significant reduction in project funding stemming from changes in PEPFAR funding priorities. The funding cut back resulted in a nearly 60 percent reduction in funds over the life of the project compared to the original funding plan, which required that the project to reduce staff numbers and close regional offices.
- Made excellent progress in increasing the capacity of implementing partners (IPs) in quality improvement of HIV/AIDS services and strengthening the Mission’s capacity to utilize SIMS data for continuous quality improvement and program monitoring, as reflected by an overall trending increase in SIMS assessment scores during the lifetime of the project.
— CPAR 2021
In addition to delivering high-quality SIMS assessments across all four years of the project, DevTech’s successful implementation of S4SIPMS was a result of its high quality capacity building and knowledge management activities, including:
- Completing a gap assessment at the beginning of the project to determine baseline knowledge and understanding of SIMS data within USAID and its IPs. DevTech critically analyzed the findings from this assessment to devise and implement a set of activities designed to address the wide disparity between the capacities of the IP supporting sites carrying out HIV/AIDS care and treatment services.
- Developing support material, such as SIMS factsheets, and a standardized SIMS remediation template. DevTech used these tools to help IPs to better understand SIMS assessment criteria and to design, document, and monitor remediation measures that would improve their delivery of health services.
- Creating documents to assist USAID IPs to better use SIMS data, including guidance documents on how to incorporate SIMS into Project M&E Plans; how to incorporate SIMS into quality improvement and knowledge management approaches; and how to incorporate SIMS data into decision making practices.
- Conducting Training of Trainers (TOT) sessions with mid-level staff from all the major USAID IPs receiving PEPFAR funding. DevTech’s trainings focused on both technical principles, such as how to analyze and use collected data, and leadership principles, such as how to identify learning styles and the most appropriate training approaches.
Success Story – Improved Waste Management at Ogoja General Hospital
In February 2021, DevTech’s S4SIPMS project staff conducted a site visit of Ogaja General Hospital. During the visit, they identified waste management as a significant gap in the quality provision of HIV/AIDS services. Infectious waste was not adequately disaggregated from general waste and the waste dump site was accessible to the public. With the information obtained through the SIMS assessments, RISE, the implementing partner that supports the site, investigated the factors contributing to poor waste management. RISE identified the root causes, which included: 1) poor knowledge of waste management, 2) poor attitude of health workers towards waste management, and 3) lack of a standard incinerator at the facility.
The Ogoja General Hospital Continued Quality Improvement (CQI) team instituted the following interventions to address these gaps:
- The CQI team visited the facility’s Medical Superintendent to discuss the issue of waste management as identified through SIMS and to advocate for remediation.
- RISE conducted sensitization trainings for facility and ad-hoc staff to create awareness on the need for proper waste disposal including adequate segregation of waste.
- The facility Infection Prevention and Control (IPC) Team was merged with the CQI Team. This has helped tremendously in ensuring adequate waste segregation and disposal. One of the outcomes of the monthly CQI Meeting (now merged with the IPC team) that took place in March 2021 was to conduct bi-weekly facility inspections to ensure all units adhere to proper waste management procedures (using the right biohazard bags and dustbins for waste segregation). This is now followed as a standard protocol in the hospital.
- With support from RISE, waste bins, biohazard bags, and signage were distributed and strategically placed within the facility to deter the public from littering the hospital.
- As part of the plan to provide a lasting solution to waste disposal, the facility partnered with the United Nations High Commissioner for Refugees in April. This collaboration resulted in the construction of an incinerator, which became effective in July 2021.
All the above strategies and interventions resulted in significantly improved and appropriate waste segregation and disposal, evidenced by the follow up SIMS assessment conducted by the DevTech team in August 2021. The pictures below show waste management at the hospital before and after the intervention.