The HIV and AIDS epidemic in Uganda is compounded by a substantial deficit in health care workers. To address the problem, the USAID Health Care Improvement Project and the Ugandan Ministry of Health implemented quality improvement (QI) collaboratives in several facilities to improve the quality and efficiency of the care provided in HIV clinics. One intervention was the “data management collaborative”. This intervention focused on improving their clinic’s medical records systems and processes. The underlying hypothesis is that improving the quality of records systems will make clinics more efficient, reducing waiting times for clients and allowing staff more time to focus on providing quality clinical care.

To evaluate the effects and costs of the data management collaborative, a pre-/post-intervention study was conducted in nine of the 17 HIV clinics in the data management collaborative. Information was obtained on the QI interventions introduced at each site and the costs incurred by implementing the intervention. Costs were compared to monetary value of the staff time saved as a result of the intervention.

Record retrieval time decreased significantly from baseline to follow-up at all sites. Changes in record completeness and the number of clients seen per staff member per week showed little association with these improvements or with any specific type of intervention within the collaborative. Seven clinics closed earlier at follow-up, producing a staff time cost saving of up to 690,000USh (US$310) per clinic day or the equivalent of 1.0 5.8 additional staff members on site each clinic day. A cost-benefit analysis using this data showed a 185,869,607USh (US$82,535) net benefit from the collaborative over 12 months.

The QI collaborative had a significant positive net benefit in the clinics providing HIV services. If the staff-time savings achieved here were reproduced in all accredited HIV clinics across Uganda this would equate to hiring between 328 and 1902 additional health care workers.