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Uganda | District Health Management Collaborative
Sponsors/partners:
USAID Health Care Improvement Project, URC, Ministry of Health Uganda, local governments of participating districts
Topics: HIV/AIDS
Region and Country: Uganda
Date improvement activities began:
February, 2008
Date of end of collaborative:
November, 2010
Aims/objectives:
The overall goal of the District Collaborative is to:
• Establish QI teams at the level of the District Health Management Teams in 39 districts of Uganda
• Institutionalize and sustain a culture of Quality Improvement (QI) within the District Health Team
Implementation package/interventions:
The implementation package for the District Collaborative consists of two aspects:
• Building capacity of District Health Teams to improve their own work at the district level, such as logistics, supervision, and human resources, using QI
• Building capacity of District Health Team to support QI work at facilities to improve HIV services
Measurement:
District Indicators:
1) Number of District QI teams trained in QI
2) Number of health facilities with functional QI site teams
3) Number of health facilities providing timely reporting/feedback to the DHT
4) Number of QI participating health facilities actively documenting changes
Site level QI indicators:
1. Indicator 1: % of HIV positive patients enrolled in the clinic and receiving general care who have been assessed for ART eligibility at every visit
2. Indicator 4:% of HIV+ patients seen in the clinic who are in general care and/or receiving ART who are assessed for active TB at every visit
3. Indicator 7: % of HIV+ patients who are eligible and ready for ART and who have been started on ART
4. Indicator 8: % of HIV+ patients seen in the clinic (general care or receiving ART) who are prescribed daily Cotrimoxazole
5. Indicator 13: % of patients on ART who are adherent to ARV medicines
6. Indicator 27: % of children born to HIV+ mothers in PMTCT who were ever tested for HIV
Spread strategy:
• During learning sessions site teams and DHTs learn from each other
• DHTs spread best practices across sites during coaching
• DHTs transfer practices o other services like immunization during support supervision
• In some district QI expert at regional level (Regional Coordinators) are part of district QI team, they spread best practices from other collaborative to their districts
Central coaches support spread of best practices to district team during coaching of DHTs, e.g. practices from Phase 1 to Phase 2
Number of sites/coverage:
There are 14 Districts participating in Phase 1 and 25 Districts in Phase 2 for a total of 39 Districts out of 81 Districts in Uganda. The total number of facilities participating in the collaborative is 74 consisting of 6 District Hospitals, 40Health Center IVs and 28 Health Center IIIs out of a total of 4639 facilities in Uganda. These facilities and Districts are located in 12 of 12 MOH regions. The estimated population covered by these sites is 6,423,034 people and 429,816 PLHIV.
Coaching:
HCI and the MOH Quality of Care Core Team and Regional Teams are training and supporting District Health Teams to coach sites in improving the quality of HIV services. HCI provided training to DHTs in QI and coaching followed by on-site training of providers in QI. HCI and DHTs coached sites jointly for three months and then allow DHTs conduct independent coaching to their sites. HCI continues to supports DHTs on quarterly basis reviewing progress of their made during independent visits.
Learning sessions & communication among teams:
Learning Sessions for DHTs cover three topics:
• QI and coaching – what are they learning, what works well
• Progress of DHTs in improving their own work
• Progress of sites being coached by the DHTs
Learning session for site
• LS1 for sites is organized at district level includes 3 sites per districts, 2 new sites and 1 old site. The old sites share their QI experience.
• Learning session 2 for sites is a combined with district learning session 2 or 3 for DHTs
• During Learning session 2 sites share and learn best practices through poster presentations
• DHTs share their best practices in groups of 3 to 5 districts, synthesis their best practices and share them in plenary
Results:
In a period of a year, facility teams in phase 1 sites improved proportion of clients assessed for TB on every visit from 70% to 95% and proportion of patients on ART who adhered to treatment from 20% to 94%. See graph in file below.
Related documents:
