This baseline evaluation in the Tanga District of Tanzania will evaluate the current scope of Home-Based Care (HBC) services and associated roles and responsibilities across stakeholders to inform the development of a framework and standard operating procedures for the HBC program.

26 facilities in the Northern Region of Uganda are participating in the collaborative improvement effort implementing the ART Framework. This study aims to understand how best practices to improve HIV/AIDS care are modified and adapted as they are spread across and implemented at these various sites, which are free to choose which changes they wish to apply and to modify those changes to suit their needs. This study will identify best practices that are being spread throughout the facilities and gather details of the implementation of specific changes. Tentatively, the following three practices will be studied: 1) giving 2-3 months supply of ARVs to adherent patients to improve retention, 2) pre-packaging medicines to reduce waiting time and ultimately improve coverage and clinic efficiency, and 3) using a screening tool for detecting tuberculosis in HIV/AIDS patients to improve clinical outcomes. The study will look at best practices that are implemented by five or more of the 26 participating facilities in order to understand how that change is modified across different sites.

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.

At the request of the Office of the Global AIDS Coordinator (OGAC), the United States Agency for International Development (USAID) and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund), the USAID Health Care Improvement Project (HCI) developed an approach to yield meaningful information about the quality of HIV services for users at multiple levels of the health system. The approach proposes 16 quality criteria (QC) that were assessed through 25 existing indicators. The indicators were based on measures previously required or recommended by funders and other stakeholders, such as the Global Fund, PEPFAR, and the World Health Organization. This report presents the findings from a field test of the approach in five countries in three world regions: Africa, Eurasia, and Southeast Asia.

This presentation was given by Amy Stern, Senior QI Advisor on HCI, 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.”