Evaluación y mejora de la atención sanitaria en la comunidad de Dialakoto, Tambacounda, Senegal

Abstract

INTRODUCTION The 2030 Sustainable Development Agenda defines, as their 3rd Objective, "Ensure healthy lives and promote well-being for everyone at all ages". In order to achieve this goal, it is necessary to strengthen and improve in healthcare in developing countries. Primary Healthcare takes special relevance in the war against healthcare inequalities, the first contact with the health system, as the paradigm of an accessible, equitable, person-centred, comprehensive and coordinated healthcare, and with the participation of the community. The Community of Dialakoto (Tambacounda, Senegal) is located in a particularly underdeveloped area, mainly due to its remote geographical location and its low-density population, The low purchasing power combined with the mobility difficulties and the scarce healthcare network entails lower accessibility as well as lower health-care quality in this community. OBJECTIVES Main objetive: - Evaluate and improve the quality of healthcare in the community of Dialakoto leveraging quality management tools. Specific objetives: - Analysis of the status of healthcare in the community. - Improvement of the healthcare structure within the community. - Improvement of health-related activities. - Improvement of health outcomes in the community. MATERIAL AND METHODS An assessment carried out before and after the establishment of the Primary Healthcare Centre (Posté de Santé) in the village of Dar Salam Fodé, with a total duration of two years . First of all, an analysis of the health conditions of the Dialakoto Community is carried out leveraging a force field analysis and a cause-effect diagram. The causal categories identified are then classified according to our capacity for action. The tasks required to achieve the desired improvement have been outlined in an Affinity Diagram. Quality criteria and quality indicators are used in order to evaluate the improvement, while a descriptive analysis is used for the aspects that can not be quantified in the form of an indicator or quality criteria. Data collection periods were: 1. November-December 2016; 2. November-December 2017; 3. July 2018 for some of the indicators, and November-December 2018. RESULTS The evaluation of the structure indicators points that the implementation of the primary healthcare centre and the recruitment of a nurse improves the ratio of healthcare "spots" and nurses per number of inhabitants, from 1/18268 to 1/9796 inhabitants, in both cases. Among the process indicators evaluated, the data related with accessibility are noteworthy, measured as the ratio of the number of external visits vs the total population, which rose from 25.2% in 2016 to 78.2% in 2018, with a rise in the total number of visits from 4597 in 2016 to 14261 in 2018. The number of prenatal visits as well as the number of visits of pregnant with at least 4 prenatal (4 PNV), rose from 778 to 1131 in the total number of visits, and from 30 to 140 in the number of pregnant (4 PNV). The total number of postnatal visits and the performance of inmediate care of the newborn after birth does not show any improvement. HIV screening in pregnant women rises from 10.4% to 76.7% in the next two evaluations. Outcome indicators show no improvement in vaccination activities. Diagnostic coverage of malaria in cases with clinical suspicion was 97.7% in 2016 and 99.9% in 2018. Obstetric complications were reduced during the assessment period from 95 cases in 2016 to 5 cases in 2018. CONCLUSIONS The use of quality management tools is useful for conducting an analysis of the healthcare situation in a region of the third world. The activities performed have been successful in the improvement of their infrastructures, the provision and the training of the healthcare professionals and improving some health outcomes of the population.