Achieving capacity for performance measurement to improve quality of care in resource limited settings: experience from six countries through HEALTHQUAL
B. Agins1, M. Palumbo1, R. Birchard1, J. Konstam1, M. Geis1, K. Smith-DiJulio1, C. Steinbock1, K. Clanon1, B. Aranda-Naranjo2, D. Parham3, G. Tidwell2, J.R. Morales2
1New York State Department of Health AIDS Institute, Office of the Medical Director, New York, United States, 2Health Resources and Services Administration (HRSA), Global AIDS Program, Rockville, United States, 3Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, Rockville, United States
Issues: Improving clinic processes and information systems is crucial to health system strengthening in resource limited settings. HIVQUAL International (HQI) offers a simple, systematic strategy for building capacity to improve HIV quality of care. Performance measurement (PM) based on sampling methodology builds capacity and strengthens health systems by increasing data analysis and system level improvement.
Description: 304 clinics across six PEPFAR partner countries (Uganda, Namibia, Haiti, and Mozambique, Nigeria, Guyana) have participated in HQI (248 exclusively adult, 30 exclusively pediatric, and 26 both). The number of clinics submitting data each year has increased from 51 in 2006 to 191 in 2009. Expansion is driven by MOH priorities with the addition of subsequent groups of clinics. To date, 57,832 of an eligible 521,606 total adult and pediatric patient records have been sampled for PM.
PM indicators are based on national clinical guidelines and address public health challenges. Currently, 19 unique core and nation-specific indicators are measured (clinic visits, CD4 monitoring, ART, ART adherence, cotrimoxazole, LTBI screening, TB clinical assessment, TB diagnostic evaluation, isoniazid prophylaxis, TB referral, TB medication documentation, HIV prevention education, post-exposure prophylaxis, weight monitoring, food security, nutritional assessment, alcohol screening, growth monitoring, blood pressure).
Lessons learned: Among four partner countries with multiple data collection rounds and comparable indicator definitions (Uganda, Namibia, Haiti, and Mozambique), 26 of the 29 indicator scores improved an average of 15% from baseline. HQI provides a feasible public health approach to building and sustaining national and site level capacity for managing and improving care.
Next steps: Looking forward, existing quality measurement programs will be scaled up in resource limited settings and opportunities to engage other countries will be explored. The HQI model will be expanded to other health services including PMTCT and well child care.
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