This presentation was given by Dr. Donna Jacobs, HCI Country Director for South Africa, at the 28th International Conference of the International Society for Quality in Health Care, Ltd. (ISQua), which took place in Hong Kong, China from September 14-17, 2011. The conference theme was, “Patient Safety: Sustaining the Global Momentum."

The Uganda Ministry of Health (MoH) Quality Improvement Strategy Meeting was convened in Kampala, Uganda, on March 21–22, 2011. The meeting provided a forum for various departments within the MoH, selected partners, and international improvement experts to share experiences, clarify the role of Government partners, and discuss lessons learned from implementing health care quality improvement initiatives at national and local levels. The MoH Quality Assurance Department (QAD) together with the United States Agency for International Development Health Care Improvement Project (HCI) organized and supported this meeting. 

Dr. Henry Mwebesa, Commissioner of QAD, chaired the meeting. Dr. M. Rashad Massoud, Director of HCI and Senior Vice President of the Quality & Performance Institute, University Research Co., LLC, designed and facilitated for the meeting.

Throughout the two days, participants shared their experiences with quality improvement (QI) efforts across multiple levels of the health sector, identified challenges and interventions while implementing QI, and made recommendations for harmonizing and sustaining QI efforts in Uganda. Examples discussed were from Uganda, Afghanistan, Sweden, Niger, South Africa, Ethiopia, Russia, and Palestine. 

This report summarizes the key discussions during the meeting.

This is the revised version of the Primary Health Care Supervision Manual developed by the National Department of Health and serves as key tool for strengthening the delivery and improving the quality of Primary Health Care services, the cornerstone of the national health care system. It follows on the earlier Clinic Supervisor’s Manual that was originally introduced to the public health sector at a national workshop in October 2000 and adopted in March 2004 for countrywide use.  Since the introduction of the Manual in 2000, the health care system has undergone significant transformational changes as a result of changes in the burden of disease in South Africa. These changes have resulted in the development of new programmes that were not included in the former manual. Materials used in this revised version draw from a number of sources, all of which have been field-tested and have proven to be very useful tools in supervising primary health care programs.

The manual contains guidelines for quality supervision, use of supervision support checklists, conducing in-depth technical program reviews, and tools for working with Primary Health Care Facility Committees. 

The United States Agency for International Development (USAID) funded Quality Assurance Project (QAP) and its follow on, the USAID Health Care Improvement (HCI) Project under URC have, since 2001, been engaged in work that is crucial for health system strengthening with respect to HIV and AIDS programmes and TB. These diseases require ongoing intervention, monitoring and treatment, and when they present on a mass scale, as they do in South Africa, necessitate measures that are not easy to institute. Indeed, an entire infrastructure has to be put in place wherever affected people require treatment, and especially so in rural areas, where rates of infection are high but medical facilities are scarce.

USAID’s QAP and HCI Projects intervened to answer this need, creating small but effective infrastructures at crucial nodes to support South Africa’s health systems, and to bolster the health of the population in general with basic health care programmes. This publication is a compilation of success stories written over an eight-year period to document developments supported by QAP and the HCI Project. 

This report presents reflections on South African supporters of DOTS, the internationally recommended strategy for tuberculosis (TB) control. The DOTS strategy has been implemented on a national level in South Africa's fight against TB, and DOTS supporters are lay health workers who provide some of the services called for by the strategy. The report draws on qualitative data from the Western Cape metropolitan area and the Nyandeni district of the Eastern Cape. While the DOTS strategy has been widely implemented, still little understood are factors such as: the extent to which TB patients value it, the experiences of supporters in providing support, the necessary conditions for ensuring a successful support program, and the likelihood of successful integration of an HIV/AIDS program into a successful TB DOTS program. The research discussed in this report focused on exploring, from the providers' and consumers' perspectives, a range of organizational factors that are perceived to be necessary to facilitate the function of the DOTS supporters. The report concludes with recommendations to health providers and policy makers to improve the delivery of care to patients with TB. It asserts that before DOTS supporter programs are implemented in a community, the formal health facilities in the area need to be fully functional. It also concludes that for DOTS supporters to be effective, some sustainable form of incentives needs to be provided. (author's)