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 web portal was developed by the Federal Research Institute for Health Care Organization and Information of the Ministry of Health and Social Development of the Russian Federation, in partnership with the USAID Health Care Improvement Project.  It includes a library of over 400 Russian language documents and links on application of improvement methods to maternal and child health and other clinical topics. The site also features a distance learning course on improvement methods and reports on applications of quality improvement methodology in the Russian Federation.

This paper summarizes 10 years of evidence of the effectiveness of collaborative improvement in improving health outcomes and compliance with health care standards. The collaborative improvement approach was designed by the Institute for Healthcare Improvement (IHI) in the United States to produce rapid, significant improvements in a targeted area of health care. The paper was commissioned by USAID and analyzes the results achieved by over 1,300 teams of health care providers who participated in 27 improvement collaboratives supported by USAID during 1998-2008.   Data analyzed consisted of 135 time-series charts representing pooled data from groups of teams from 12 countries. All together, the data covered 81 distinct measures of compliance with standards and outcomes for maternal, newborn and child health, HIV/AIDS care, family planning, and malaria and tuberculosis diagnosis and treatment.

This study investigated the barriers preventing people with HIV/AIDS from accessing specialized medical care, specifically ART, and developed recommendations to increase ART availability and treatment adherence in HIV-positive, hard-to-reach patient groups in St. Petersburg and Orenburg. Structured interviews were held with 551 PLWHA—including injection drug users, commercial sex workers, and PLWHA in self-registered groups—as well as with focus groups and subject experts. Drug abuse, alcohol abuse, and individual experience (e.g., experiencing pain) were the most influential factors associated with accepting/not accepting ART. The study’s recommendations are targeted toward four audiences—the general population, the medical and social care system for PLWHA, the closest social contacts of PLWHA, and individual PLWHA— and vary by city, largely due to variances in trust in different media between the two cities.

Related publication: Decentralization of HIV Care in St. Petersburg, Russia | Accessibility of Antiretroviral Therapy in St. Petersburg and Orenburg City, Russia

Assurance Project (QAP) began to work with federal and regional health authorities in the Russian Federation to apply the improvement collaborative approach to design a model system on HIV/AIDS treatment, care and support in pilot sites in four cities: St. Petersburg (one of 18 districts), Orenburg, Engels, and Togliatti. The aim of the demonstration collaborative was to develop a municipal model for delivery of integrated treatment, care and support services, including tuberculosis (TB) testing and treatment, to persons living with HIV/AIDS (PLWHA). QAP worked with selected organizations in the four regions to develop a system for all HIV-positive patients to be tested for TB, receive Isoniazid preventive therapy (IPT) and, if necessary, be treated for TB. Key partners included local health authorities, infectious disease specialists from AIDS Centers and polyclinics, TB specialists, substance abuse specialists, social service providers, NGOs, and PLWHA.

Arterial hypertension (AH) is a major cause of mortality in Tula Oblast, Russia, where 27 percent of the population is believed to have the condition but only 10 percent have been diagnosed. In addition to the human suffering and loss, the toll on the healthcare system was burdensome. A US-Russia team of oblast leaders, healthcare providers, and quality assurance experts examined the then-current system, proposed evidence-based changes that were introduced gradually and monitored for their effect, and revised the system so that AH could be identified early and people with AH could learn healthy behaviors. This report presents the guideline that serves as part of that system; results are included in the Report Improving the System of Hypertension Care in Tula Oblast.

The fall of the Soviet Union in 1991 signaled a turning point for the region. Scores of weapons factories closed, and the network of work site polyclinics or medsanchasti had to be integrated into the remaining system of clinics and hospitals. In addition, the entire healthcare and insurance system underwent massive restructuring. Since hypertension care had been largely the responsibility of these work site polyclinics, management of care for individuals with hypertension was disrupted during this period. Many patients simply continued to take previously prescribed medications; others were apparently untreated and even undiagnosed. The region began witnessing a marked increase in the prevalence of complications of uncontrolled hypertension, in the form of myocardial infarctions, strokes, hypertensive crises, and uncontrolled blood pressure. In fact, by 1998, the main cause of adult mortality in Tula was cardiovascular disease, primarily from complications of hypertension. This has been a countrywide pattern; unrecognized and untreated hypertension in Russia has been cited as a major contributor to cardiovascular disease. In turn, cardiovascular disease is estimated to be responsible for one-half of the excess mortality in the Russian Federation, where mortality rates have steadily increased since the 1960s, largely affecting adult males in their most productive years. (excerpt)

The Quality Assurance Project/ Russia implemented a quality improvement (QI) demonstration project in 1998 at three hospitals in Tver Oblast, Russia. The project sought to improve the quality of care for women with pregnancy-induced hypertension (PIH), then the single largest cause of maternal deaths in Tver. Central to the QI effort was the development and introduction of evidence-based clinical guidelines for the management of PIH. The new guidelines rationalized admission criteria and the use of drugs, reduced the number of PIH admissions, and called for more aggressive treatment of PIH. Health outcomes improved following the introduction of the new guidelines. Complications in newborns of PIH mothers dropped, no PIH case progressed to eclampsia (which is often fatal), and no maternal deaths caused by PIH occurred in the 15 months following the implementation of the new guidelines. A before-and-after cross-sectional cost study at two of the three pilot hospitals found that PIH admissions decreased by 77 percent in the six months following introduction of the new guidelines compared to the previous six months (from 47 cases before to 11 after). This decrease is consistent with the new, more stringent guidelines and indicates a high likelihood that compliance with the new guide lines caused the decrease. The cost study measured PIH-related direct costs for inpatient and outpatient cases. The former included the cost of hospitalization (clinical services, food), drugs, lab tests and other paraclinical services. The latter included antenatal care-related costs and costs associated with PIH and other conditions: drugs, lab and other paraclinical care, and medical consultations. Total direct inpatient-related costs decreased by 86 percent, from about 51,000 rubles in the Before group to about 7,000 rubles in the After group. This is an annualized savings of about 118,000 rubles (about US$ 4,720 at the time of the study). Direct perinpatient costs decreased 41 percent. As expected, costs were higher for women with more severe PIH, but a substantial decrease was evident at all severity levels following the introduction of the new guidelines, with the larger decreases occurring in the more severe cases. Length of hospital stay for PIH women also decreased, on average from 13.5 to 11.8 days. Findings also suggest that outpatient costs potentially associated with PIH care also dropped by roughly 13,000 rubles per year, although an inability to separate PIH costs from regular antenatal care costs makes it difficult to pinpoint the decrease with certainty. Although the number of cases in each study group is small, and numerous assumptions are made in the analysis, no substantial threats to the validity of these findings are apparent. The unusual result of having health outcomes improve at substantially lower operating costs recommends wider application of the demonstration project. (author's)