Improving Death Reporting in Uganda

In Uganda, keeping track of how and why people die can be a tricky business. You’d think that with all the technology we have, this should be straightforward, but it turns out that death reporting can be about as organized as a cat at a dog show. Accurate records of deaths help the government understand public health better, respond to disease outbreaks, and plan health services. Unfortunately, many deaths go unreported, leading to a huge amount of missing information.

#The Situation in Uganda

Countries around the world have different rates of death registration. In developed regions like Europe and America, nearly every death is recorded. In contrast, Uganda struggles, managing to register only about 11% of deaths. The World Bank estimates that Uganda had a crude mortality rate of 6.4 deaths per 1,000 people in 2022, which translates to over 283,000 deaths that year. Out of those, the majority, about 67%, happened in communities rather than in hospitals.

So, what happens when people die in hospitals? You might think there would be a well-organized system to report those deaths, but that’s not quite the case. For example, at Mbale Regional Referral Hospital, which is the largest hospital in the Bugisu subregion, only about 5% of deaths were properly documented. This means that important details about the causes of death are lost in the shuffle, making it tough for health authorities to improve care and allocate resources effectively.

#What Went Wrong?

Why is it so hard to get accurate mortality data? There are several reasons. First, many healthcare workers lack training on how to fill out the required forms correctly. This can lead to errors or a complete lack of paperwork. Imagine being asked to fill out a form when you have no clue how! On top of this, healthcare providers are often overwhelmed with their regular duties. When busy with patient care, filling out paperwork can feel like a chore you’d rather put off.

Then, there are logistical issues. Sometimes the forms required for reporting are just not available. You could say it’s like trying to buy ice cream in the winter—sure, it’s great to have, but if the shop is closed, it’s not happening!

Finally, many staff members don’t see the value in the reporting process. If the hospital leadership isn’t emphasizing the importance of these reports, why would anyone prioritize completing them?

#A Quality Improvement Project

Recognizing these challenges, a project was launched in 2023 at Mbale Regional Referral Hospital to tackle the problem head-on. The goal was simple yet ambitious: increase the rate of death notifications from a meager 17% to a more respectable 80% in just six months. That’s like trying to go from barely passing math to acing it with flying colors!

The project employed a method called Continuous Quality Improvement (CQI), which is all about making ongoing improvements based on data and feedback. By using this method, the project aimed to identify the root causes of the problem, develop solutions, and implement changes that would improve how mortality reporting is done.

#Getting Organized

To kick things off, the project team held an inception meeting with hospital management and department heads to introduce the project and outline its goals. It was essential to have buy-in from the top, as everyone needed to understand and support the changes being proposed.

Next, a Quality Improvement Team was formed, pulling together clinical and nursing staff who had a passion for improving healthcare at the hospital. They were trained in CQI processes and mortality surveillance to help them identify issues, set goals, and develop effective actions.

#Assessing the Situation

Before diving headfirst into solutions, the team conducted a baseline review to understand the current state of death reporting at the hospital. They analyzed existing data on deaths and the forms submitted, along with gathering insights through questionnaires to identify gaps that needed to be plugged.

Along the way, they discovered three main problems:

1. Failure to complete the HMIS Form 100 immediately after a death.
2. Inadequate knowledge of how to use the forms.
3. Frequent lack of physical forms when needed.

#Understanding the Challenges

To dig deeper into the issue, the team conducted focus group discussions with healthcare staff to understand their experiences with the mortality reporting process. They learned that many healthcare workers felt overwhelmed with their responsibilities and did not see the importance of timely death reporting.

When it came to the forms, staff admitted to not being trained on how to fill them out properly, leading to confusion and errors. And as mentioned earlier, sometimes the forms just weren’t available. If you can’t find a pen, how will you fill out the grocery list?

#Prioritizing the Problems

Once the main issues were identified, the team had to prioritize them based on their importance. They assigned scores to each problem to see which ones needed to be tackled first. The results were illuminating:

• The biggest challenge was failing to fill the HMIS form 100 correctly and on time, followed closely by a lack of knowledge about how to use the forms.

With this ranking in hand, the team created a clear aim statement. They set out to increase the number of properly filled HMIS forms right after deaths occurred, establishing a target of 80% by April 2024.

#Developing Solutions

With the problems sorted out, it was time to come up with practical solutions. One of the first steps was to train staff on the importance of timely reporting and how to fill out the forms. Think of it as a crash course in death reporting, but one that was designed to be supportive and informative rather than scary or punitive.

The team introduced a structured process for filling out the HMIS form 100, ensuring that nurses knew what to do immediately after a patient’s death. The goal was to make mortality reporting as automatic as breathing.

They also started mentoring staff and providing additional training sessions to keep everyone updated on best practices. These efforts were accompanied by a commitment to ensure that the necessary forms were stocked up and ready when needed. After all, who wants to fill out a form when the supplies are missing?

#Monitoring Progress

Throughout the project, the team closely monitored how things were going. They tracked progress with monthly check-ins to see how many forms were being filled out. This was important not just for accountability but also to adjust their strategies based on what was working and what wasn’t.

As the months rolled by, improvements began to surface. While the target of 80% wasn’t quite achieved, the number of timely death notifications surged from 18% to an impressive 65%. That’s quite an accomplishment!

#Reflecting on Successes and Challenges

This quality improvement project didn’t just change paperwork; it made a clear difference in the way mortality reporting was seen within the hospital. Staff were now more aware of the importance of accurate reporting, and results improved.

However, challenges still remained. The team recognized the need for ongoing training to maintain momentum and ensure that new staff understood the processes. They also needed to keep pushing for a culture that values mortality reporting—not just during a project, but as an integral part of hospital operations.

#Lessons Learned

From this project, several key lessons emerged. Foremost among them was the understanding that addressing knowledge gaps among staff is essential. When people don’t know how to do something, they won’t do it.

The importance of consistent support and resources was another big takeaway. Ensuring that the necessary forms were on hand at all times is crucial for timely reporting. And finally, reinforcing the value of mortality reporting at all levels of hospital management can create a much stronger culture around it.

#Future Directions

The initial changes made at Mbale Regional Referral Hospital can serve as a model for other health facilities. With ongoing efforts to educate staff, reinforcing the importance of accurate data collection, and overcoming logistical issues, hospitals across Uganda can improve their mortality reporting.

#Conclusion

In summary, while the road to improved death notification in Uganda is still a work in progress, the steps taken at Mbale Regional Referral Hospital show promise. Although they didn’t quite meet the ambitious 80% target, moving from 18% to 65% is no small feat.

With the belief that every bit of accurate information contributes to better health outcomes, the project team continues to strive for improvements. They’re not just filling out forms; they’re building a stronger healthcare system, one report at a time. And who knew a little paperwork could lead to such progress?