{"presentation":{"slides":[{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":91.50326797385621,"height":25.91792656587473,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Root Cause Analysis of Low Performance in Percentage of Target TB Notification Achieved<\/strong><\/p>\n\n

Low performance means notification of TB cases is not happening as desired.<\/p>\n\n

Data is available in Ni-kshay and analysed in terms of: <\/p>\n\n

<\/p>\n"},"subContentId":"d7ad05e9-c3a4-4f70-9927-33647e0fba95","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":8.711764705882354,"y":41.121166306695464,"width":41.394335511982575,"height":56.15550755939525,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Place Analysis<\/strong><\/span><\/p>\n\n

Whether the notification is less from a geographical area? (Peripheral Health Institute (PHI)\/ TB Unit (TU), private hospital)<\/p>\n\n

e.g., less notification from a particular PHI may be due to a newly recruited Medical Officer (MO) who is not trained in National TB Elimination Programme (NTEP). The solution should aim at training the MO to improve the notification from that PHI.<\/p>\n\n

<\/p>\n"},"subContentId":"19346ead-3a69-49e9-bb2f-39df79a4f614","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":53.37690631808279,"y":41.03671706263499,"width":42.48366013071895,"height":56.803455723542115,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Person Analysis<\/strong><\/span><\/p>\n\n

Whether the notification is less in special age group\/ gender\/ population group?<\/p>\n\n

e.g., teen-aged female patients due to attached stigma. Identification of the stigma by such analysis might be helpful in planning stigma reduction campaigns\/ Advocacy, Communication and Social Mobilisation (ACSM) activities to enhance notification.<\/p>\n"},"subContentId":"93b91ac2-eb77-40e9-8421-0835dcd32a78","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":40.30501089324619,"y":30.23758099352052,"width":7.734204793028323,"height":15.33477321814255,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64f5d2db4c667.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512}},"subContentId":"d07f09ab-ea79-4a17-a981-aa786512e85f","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":84.96448801742919,"y":28.10583153347732,"width":8.714596949891067,"height":17.278617710583152,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64f5d2e93110d.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512}},"subContentId":"8f1f0f31-4d2c-4630-b1d1-182f5cec5abf","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":51.19542483660131,"y":32.45917926565875,"width":0.32679738562091504,"height":62.634989200863934,"action":{"library":"H5P.Shape 1.0","params":{"line":{"borderWidth":"2","borderStyle":"dotted","borderColor":"rgb(188, 188, 188)"},"type":"vertical-line","shape":{"fillColor":"#ffffff","borderColor":"#000000","borderWidth":"0","borderStyle":"solid","borderRadius":"0"}},"subContentId":"1be598f0-5d07-41ec-89df-cbcaba0fc320","metadata":{"contentType":"Shapes","license":"U"}},"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":23.758099352051836,"width":92.5925925925926,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

e.g., festive season and marriage season might have less notification, as many patients neglect cough or chronic ill-health. However, this might be dangerous as the probability of spread during such festivals and marriage functions is quite high. Such analysis gives insights for enhanced active case finding during these seasons.<\/p>\n\n

<\/p>\n"},"subContentId":"d9c4a683-7935-4790-8e61-59851bb65fa6","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":6.479481641468682,"width":56.64488017429194,"height":17.278617710583152,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Time Analysis <\/span><\/strong>
\n
\nWhether there is a change in notification trends across months?<\/p>\n"},"subContentId":"ff2ede9c-b0aa-44fc-b01a-a13b6013a458","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":87.14596949891067,"y":2.159827213822894,"width":8.714596949891067,"height":17.278617710583152,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64f5d40ca43fc.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"subContentId":"116a3e00-cd07-471b-a4fa-a3d56354b2e9","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":21.78649237472767,"y":49.676025917926566,"width":55.55555555555556,"height":41.03671706263499,"action":{"library":"H5P.Shape 1.0","params":{"shape":{"fillColor":"rgb(244, 203, 167)","borderWidth":"0","borderStyle":"solid","borderColor":"rgb(249, 225, 214)","borderRadius":"0"},"type":"rectangle","line":{"borderColor":"#000000","borderWidth":"1","borderStyle":"solid"}},"subContentId":"819fcf78-065a-4111-895f-238a4c7d587b","metadata":{"contentType":"Shapes","license":"U"}},"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false},{"x":21.783660130718953,"y":49.77732181425486,"width":54.46623093681917,"height":43.196544276457885,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

\n\t
The notification depends on the presumptive TB examination rate.<\/li>\n\t
Look at the trends of presumptive examination rate.<\/li>\n\t
Presumptive TB Examination reflects the effort to find TB cases and it should be high to reach 2000-3000 per lakh population.<\/li>\n<\/ul>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"f42778fc-f20e-4823-9fc1-3d850e2c20d7"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":10.893246187363834,"y":60.47516198704104,"width":9.803921568627452,"height":19.43844492440605,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64f5d493da2f8.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"subContentId":"6f0097fa-e3ca-460f-88ed-562ed9e7f81f","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":1.0893246187363834,"y":10.799136069114471,"width":98.03921568627452,"height":88.55291576673866,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Domains<\/strong><\/span><\/td>\n\t\t\t Possible Problems<\/strong><\/span><\/td>\n\t\t\t Suggested Solutions<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Patient<\/td>\n\t\t\t \n\t\t\t
- Lack of awareness regarding TB symptoms, fear of stigma\/ lack of motivation to seek health care<\/div>\n\n\t\t\t
- Accessibility to health care services<\/div>\n\n\t\t\t
- Financial reasons<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
- Advocacy communication and social mobilisation (ACSM)<\/div>\n\n\t\t\t
- Targeted Information, Education and Communication (IEC) for high-risk groups<\/div>\n\n\t\t\t
- Community mobilisation through Accredited Social Health Activists (ASHA), Non-government Organisations (NGOs), volunteers<\/div>\n\n\t\t\t
- Steps to set up a Designated Microscopy Centre (DMC), if indicated<\/div>\n\n\t\t\t
- Steps to minimise out-of-pocket expenditure through mobile testing facilities and point-of-care testing<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
PHI<\/td>\n\t\t\t \n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t
<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\t Is the poor referral for testing due to:\n\n\t\t\t\t\t\t
- Presumptive TB cases not seeking care<\/div>\n\n\t\t\t\t\t\t
- Due to deficient knowledge of the staff<\/div>\n\n\t\t\t\t\t\t
- Due to lack of facilities for sputum collection\/ transportation<\/div>\n\n\t\t\t\t\t\t
- Due to lack of diagnostic services<\/div>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t<\/tbody>\n\t\t\t<\/table>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
- Vulnerability mapping of all the residents of the PHI area to identify high-risk cases and conduct active and intensified case-finding efforts<\/div>\n\n\t\t\t
- Provider-oriented IEC, training and periodic reinforcement<\/div>\n\n\t\t\t
- Arrange facilities for sputum collection and transportation(Hub and spoke model)<\/div>\n\n\t\t\t
- Enquire regarding the possibility of a DMC in the area<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n<\/div>\n"},"subContentId":"9b3bd44e-642f-4393-b940-0f7e3ca7e449","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":4.319654427645788,"width":78.43137254901961,"height":5.183585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Some of the reasons and suggested solutions for decreased TB notification are listed below:<\/p>\n"},"subContentId":"2918485e-4267-4c19-b722-f4c3aeff0672","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":1.0893246187363834,"y":6.479481641468682,"width":98.03921568627452,"height":90.71274298056156,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Domains<\/strong><\/span><\/td>\n\t\t\t Possible Problems<\/strong><\/span><\/td>\n\t\t\t Suggested Solutions<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Private Hospital<\/td>\n\t\t\t \n\t\t\t
- Deficient knowledge of the provider regarding the NTEP programme\/ TB notification<\/div>\n\n\t\t\t
- Lack of diagnostic facilities<\/div>\n\n\t\t\t
- Lack of trust in the system or poor rapport with NTEP staff<\/div>\n\n\t\t\t
- Fear of losing the patient<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
- Provider-oriented IEC, training, capacity building and periodic reinforcement steps for linkage to a diagnostic facility or enquire the possibility of setting up one through the PPP model<\/div>\n\n\t\t\t
- Steps for private sector engagement<\/div>\n\n\t\t\t
- Establish a system for diagnosis notification and treatment support for TB cases and supportive supervision<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
Testing and Diagnosis<\/td>\n\t\t\t \n\t\t\t
- Lack of skilled Human Resource (HR)<\/div>\n\n\t\t\t
- Lack of facilities<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
- Arrange to recruit more HR\/ training available HR<\/div>\n\n\t\t\t
- Periodic training and reinforcement, monitoring and quality check helps<\/div>\n\n\t\t\t
- Ensure adequate supply chain management<\/div>\n\n\t\t\t
- Linkage to diagnostic facilities\/ set up new facilities <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
Notification<\/td>\n\t\t\t Not entering the data to Ni-kshay due to:\n\t\t\t
- Lack of awareness<\/div>\n\n\t\t\t
- Technical reasons - internet issues<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
- Training and capacity building along with periodic reinforcement, proper monitoring <\/div>\n\n\t\t\t
- Steps to minimise the internet connectivity issues<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n<\/div>\n"},"subContentId":"d7a7ca45-3caf-4fa5-85d6-db7bcc96610e","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":1.0893246187363834,"y":10.799136069114471,"width":98.03921568627452,"height":34.557235421166304,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\n\t\n\t\t\n\t\t\t\n\t\t\t
Domains<\/strong><\/span><\/td>\n\t\t\t Possible Problems<\/strong><\/span><\/td>\n\t\t\t Suggested Solutions<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Other causes<\/td>\n\t\t\t \n\t\t\t
- Is the number needed to test to detect one case of TB high?<\/div>\n\n\t\t\t
- If so, is the estimated target is correct?<\/div>\n\t\t\t<\/td>\n\t\t\t
Brainstorm with District TB Officer (DTO)\/ State TB Officer (STO), and the stakeholders to reach a conclusion<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n<\/div>\n"},"subContentId":"964207a5-bb3b-4adb-bc32-3c94a8081040","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":false,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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Root cause analysis for Low Performance in Percentage of Target TB Notification Achieved