This short report describes the technical assistance that the USAID Health Care Improvement Project (HCI) is providing the Ministry of Health in Uganda to better the quality of maternal, newborn and child health by applying improvement methods that adapt and spread evidence based practices across facility and community teams in central Uganda.
Since November 2009, the USAID Health Care Improvement Project (HCI) has been supporting 96 health facilities across Uganda to improve the quality of HIV care services by applying improvement methods that enable sites to rapidly test changes in care processes to achieve better outcomes and spread these changes among all sites through peer-to-peer learning. This short report describes how HCI is supporting the Ministry of Health to institutionalize the capacity to do continuous quality improvement in HIV coverage, retention and clinical outcomes.
Uganda has both limited resources and an increased demand for health services due to the chronic care required to maintain antiretroviral therapy for people living with HIV/AIDS (PLHA). Over the past several years in Uganda, many health facilities have adopted strategies to shift some facility and community-based tasks to “expert patients,” clients who are recruited and trained to provide support services for other clients in facilities and in communities.
Several factors are associated with HIV patient enrollment, retention in ART care and treatment outcomes. These factors can broadly be categorized into patient and health facility factors. To improve the quality of HIV care services at health units, there is need to account for the modifiable and fixed characteristics of the health units. This study investigated the relationship between characteristics of the facility and the changes in quality of care indicators in the context of an intervention to improve services delivered in the facilities.
The study found very few significant associations between characteristics of the participating facilities examined in this study and their performance in the improvement intervention. The variation in improvements seen in clinics may be due more to other characteristics of the facilities not measured, such as the types of patients they serve. Based on our findings, we recommend that facilities working to improve performance in service delivery focus on changing factors identified as causes of deficits in quality independent of considerations of the immutable characteristics of their facility. Any future study on this topic should take into account patient factors because patients with certain characteristics associated with HIV treatment indicators might be unevenly distributed among the facilities.
A final version of this study will be avaible soon.
Quality improvement is becoming an important component of health care world over and there is growing recognition in the literature of the contribution patients can make to improving health outcomes (Coulter 2007, Groene 2005). Given the increasing prevalence of chronic illnesses, there is a need to have patients play an active role in their health care. This study will examine the extent to which selected interventions successfully engaged clients and providers together in quality improvement activities (problem identification, problem analysis, solution identification, and testing and implementing changes) in HIV/AIDS care clinics (in comparison to control clinics) in Uganda, and what health care providers’ and clients perceptions are on clients’ active participation in the process.
This pre/post qualitative evaluation will include six intervention and six control sites. HCI coaches will provide feedback to the intervention sites and present to them a selection of interventions to increase client involvement. Sites will be invited to select the interventions that best suit their facility’s needs and resources.
HCI is working on improving the linkage of HIV+ pregnant women to chronic HIV/PMTCT services in 19 health facilities in the Eastern region of Uganda. Quality improvement teams at these sites will test changes aiming to improve these linkages. The effectiveness of these changes will be monitored by selected indicators. Changes that are found to be successful based on monitoring the indicators will then be shared across all 19 facilities. It is expected that by the end of the demonstration period there will be a list of effective changes that can then be spread to more facilities across Uganda.
HCI has been implementing centrally organized collaborative improvement, with coaching provided by technical experts outside the MOH hierarchy, in 113 sites in Uganda to improve health care for patients with HIV/AIDS since 2006. In 2008, HCI introduced a district-based coaching strategy using MOH district management structures, as an alternative to centrally organized coaching, to facilitate sustainability of the approach and encourage its institutionalization and greater country ownership in the Ugandan health system.This study’s goal was to measure the relative efficiency and effectiveness of the two strategies in achieving improvements in process indicators.
The final study report can be found here.