Determined Leadership Helps Xhosa Clinic Improve Service Delivery to the Community

Nurse Kgakololo James in her office at the Xhosa Clinic. {Photo credit: N. Kupe / MSH}Photo credit: N. Kupe / MSH

A journey of many miles begins with a single step. Xhosa Clinic has taken many determined steps in the journey to improve the quality of care to the community, thanks to the leadership of Kgakololo James, the nurse-in-charge at the clinic.

Xhosa Clinic in Mahalape, a small town in the Central District of Botswana on the edge of the Kalahari Desert, is one of 11 health facilities enrolled in the Quality Improvement Leadership (QIL) program. QIL is a Botswana Ministry of Health (MOH) pilot program to improve service delivery through international accreditation of health facilities. The Building Local Capacity (BLC) for Delivery of HIV Services in Southern Africa Project coordinates the QIL with funding from PEPFAR.

Results of the 2009 baseline survey conducted by the Council for Health Service Accreditation of Southern Africa, the BLC partner in the QIL program, identified all the 11 service elements as partially compliant or noncompliant. “It was tough,” recalled nurse James. “We did not know where to start. We were not compliant in more than 50 percent of service elements, and some were critical criteria. BLC then conducted workshops on leadership development and showed us how to use tools like the Challenge Model to help us identify and address the many challenges we had.”

Walking around the compact clinic yard, nurse James proudly points out the improvements that have come through implementing the QIL. “Our latest acquisition is these metal scraps,” she says. “Next time you come here, they will have been transformed into cages to house our gas cylinders. I personally went to the old hospital to get these discarded materials,” James reports with a laugh, adding that she is always scanning her environment for materials to improve her clinic.

At the back of the clinic are two sets of large, sturdy plastic bins, the red containing clinical waste and the black containing nonclinical waste. They are sheltered by a makeshift tin roof and enclosed in a fence. “Now we have two sets of bins to separate the rubbish,” nurse James explains. “Previously we had the bins under a tree where the dogs could scavenge. Now we can close the gate to manage the waste, and we control the spread of infections.”

Nurse James emphasizes that patients’ welfare is at the core of the work she and her staff do to improve the clinic. “This program has taught us to be more open to assessment. We regularly ask the patients to rate our services, and we work hard to improve the weak areas,” she asserts.

At the last sampled validation in June 2012, Xhosa Clinic’s overall score stood at 77 out of a minimum of 80 points required for accreditation. The MOH is addressing the outstanding infrastructural challenges to ensure accreditation in 2013.

In Botswana the USAID-funded BLC project provides targeted technical assistance to the MOH and 11 health facilities to overcome the challenges to improve their service delivery and advance toward becoming internationally accredited. Although not yet accredited, Xhosa Clinic is one of two facilities showing the most improvement. BLC is also implementing the QIL in two hospitals in Namibia.