The overall objective of this cross-sectional study is to measure the effect of the HCI-supported collaborative to improve the quality of services for PLWHA on client satisfaction, provider satisfaction, and HIV services. The study will include an exposed group and an unexposed group. Pilot sites that participated in the collaborative improvement effort will be included in the exposed group and sites that received no quality program will be counted among the non-exposed group.

This technical report describes results achieved during the demonstration phase of an improvement collaborative implemented in Cote d’Ivoire by the USAID Health Care Improvement Project (HCI), the National Program for the Medical Management of People Living with HIV/AIDS (PNPEC), and the Ministry of Health and Public Hygiene in order to improve the quality of HIV services.

An initial evaluation of the quality of care and treatment for persons living with HIV (PLHIV) was conducted from July – August 2008 in 33 health care centers throughout Cote d’Ivoire in order to draw attention to the need for improvements among different components of care and treatment services. After the restitution of the results of the initial evaluation and the establishment of the elements of an improvement collaborative, 41 sites were selected to participate in the demonstration phase of the collaborative. Of these 41 sites, 34 provide prevention of mother to child transmission of HIV (PMTCT) services, and 38 provide anti-retroviral (ARV) treatment services.

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.

Ethiopia’s Health Extension Program (HEP) works to improve access to and utilization of care, recognizing that a major factor underlying the poor health status of the country’s population is the lack of physical access to health services. The program has deployed more than 30,000 frontline community health workers in health posts in rural communities across Ethiopia where they deliver services in four major areas. Health posts are expected to be staffed by two female Health Extension Workers (HEWs), women nominated by their communities and receive one year of training in public health, hygiene, health promotion, and certain interventions. Oversight, training, and support of HEWs are provided by Health Centers. HEWs train and supervise at least one volunteer Community Health Worker (vCHW) to provide health education and promotion services as well as make referrals.

To date, the HEP has resulted in encouraging achievements such as access to sanitation, increased immunization, family planning, malaria services, and cost-effective DOTS programs (Datiko and Lindtjorn, 2010). The success of the program can be linked to key factors including political commitment of both health and political stakeholders and local ownership by communities and local political bodies. However, studies have shown that the HEP requires improvement in certain areas of management and health services such as supportive supervision from the Woreda level (Negusse et al., 2007), supplies of drugs and equipment, a well established referral and follow-up system, good transportation and communication systems, and in-service refresher training (Haines et al., 2007). The absence of these factors has placed limitations on the effectiveness of HEP and the performance of HEWs and vCHWs.