ISBN-13: 9783030431143 / Angielski / Miękka / 2020 / 245 str.
ISBN-13: 9783030431143 / Angielski / Miękka / 2020 / 245 str.
By Tamar Chitashvili and Ekaterine Cherkezishvili, University Research Co., LLC
This case study describes the experience of a multi-facility quality improvement team in Imereti’s Samtredia District in Georgia that addressed the quality of care for respiratory tract infections among children. The case study details the design and implementation of the improvement effort, and provides details about the capacity building and coaching support provided to the team that helped lead to improved health outcomes.By Taroub Faramand, WI-HER, LLC
In partnership with Uganda's Ministry of Health, United States Agency for International Development (USAID)-funded projects joined expertise in quality improvement and nutrition to put into practice an initiative that addressed all aspects of ensuring healthy HIV-free infants. This case study focuses on how a successful pilot team in eastern Uganda used quality improvement tools to identify clinic inefficiencies and put into action a plan to eliminate mother-to-child transmission of HIV and improve nutrition assessment, care and support services.By Nilufar Rakhmanova, FHI 360
Because TB and HIV programs in Ukraine functioned separately as vertical programs—focusing on specific health conditions—they often missed a window of opportunity for diagnosing HIV at an earlier phase of infection. This case study describes how a successful pilot team in Chervonograd, Ukraine used quality improvement methods to raise the rates of HIV counseling and testing offered to clients tested for TB and how the team scaled up its successes to other sites.By Flora Nyagawa, University Research Co., LLC
This case study describes a quality improvement approach to ensure implementation of the National Quality Improvement Guidelines for Most Vulnerable Children in Bagamoyo District, Tanzania. The case study largely focuses on the steps needed to organize improvement efforts; including how project participants formed teams, carried out introductory visits, initiated district and ward efforts, conducted baseline assessments, and built capacity.By Elena Hurtado, University Research Co., LLC
In Guatemala, quality improvement and collaborative learning methods were applied to two social and behavior change (SBCC) interventions to strengthen families' health and nutrition-related knowledge and behaviors. This case details the organization of the quality improvement effort and team formation, the role of coaches, and explores challenges to making the improvements a permanent part of health services.By Nigel Livesley, University Research Co., LLC
The Government of India, concerned with poor antenatal care outcomes in Chamba district, enlisted the help of a USAID-funded project with decades of experience in quality improvement. Healthcare practitioners and district officials were initially skeptical about the efficacy of quality improvement methods and reluctant to receive external technical assistance; however, the success of the program eventually won over key stakeholders. This case explores the role of leadership and early successes in creating buy-in for a quality improvement intervention, and the role the support of key stakeholders played in the scale-up of the effort.By Barton Smith, Edmonds Family Medicine, formerly with Abt Associates
In the Kyrgyz Republic, quality improvement methods were used to promote rational antibiotic use among prescribers. This case highlights the important role data collection, access, and analysis played in identifying and reducing incorrect prescription of antibiotics.By Herbert Kisamba, University Research Co., LLC
With the expansion of health coverage in Uganda, the government began to shift its priorities to emphasize quality of health care and patient safety. In Kaborole District, the government decided to target timely ordering of medicines and tuberculosis treatment for district-level quality improvement work because these were two of the worst areas of performance within the health system. The intervention provided an opportunity to the senior-level staff of the district health system to appreciate modern quality improvement methods and apply them.By Linley Hauya, University Research Co., LLC
Malawi was one of the first countries to integrate nutrition assessment, counseling, and support into its HIV and TB care framework and the government intended the provision of ready-to-use therapeutic food (RUTF) to be a cornerstone of care. However, incomplete national-level data on the number of people requiring RUTF frequently led to supply-shortages. Because RUTF was frequently unavailable, many health facilities did not bother recording the number of patients requiring it. This case discusses how district quality improvement teams were able to address this vicious cycle to improve patient care.By Eric Baranick, University Research Co., LLC
In mid-2015, the Zika virus arrived in Brazil; within a year, the virus had travelled to 21 other countries in the Americas. As the magnitude of the epidemic unfolded, new and troubling evidence emerged about an uptick in birth defects in Zika-affected regions and their potential link to this virus, causing the WHO to declare Zika a public health emergency of international concern. This case explores the actions required to build a foundation for and implement quality improvement in a crisis setting.By Joshua Bardfield, HEALTHQUAL International
In Haiti, an electronic medical record system drives national and local quality improvement efforts as part of a national quality management program supported by the U.S. President’s Emergency Plan for AIDS Relief. This case study describes how quality improvement teams transitioned from a paper-based to an electronic medical record system and how the government used analysis of the electronic data to set improvement priorities.By Edgar Necochea, Jhpiego
Although more than half of deliveries in Mozambique occur at health facilities, high maternal mortality rates have persisted as a public health issue. To address concerns about the quality of health facility care, the Mozambique Ministry of Health launched the Model Maternities Initiative from 2009-2014, which represented about half of all maternities in the country, covering approximately one-third of all institutional deliveries. As part of this initiative, quality improvement teams used a standardized assessment tool to identify performance gaps and put in place rapid interventions—such as basic infection prevention practices and minor infrastructure repairs—to produce swift results. This case study demonstrates how it is possible to systematically improve the delivery of health services at the facility level, across an entire country, with very limited external assistance – despite the challenges faced, which are common to many low-income settings.By Nicole Spieker, PharmAccess
Introducing international standards, stepwise certifications, and a transparent rating and improvement program to healthcare providers in Kenya has proven to be a successful approach towards sustainable quality assurance. This case study explores the introduction of medical and business quality standards at a single health facility and outlines the activities that were required to adhere to the new standards.By John Byabagambi, University Research Co., LLC
Voluntary medical male circumcision (VMMC) has the potential to significantly reduce HIV transmission; however, as with any medical procedure, there is a need to assess the quality of VMMC service provision to ensure that procedures are safe and follow established norms and protocols. This case describes the experience of adapting VMMC assessment tools from high-income counties to the Ugandan context in a large number of health care facilities throughout the country and using these customized tools to address gaps in VMMC service delivery.A glossary of terms related to quality improvement is included at the end of the book. Examples of such terms that would be included are provided below:
Accreditation
Aim
Coaching
Collaborative improvement
Institutionalization
Learning session
Plan-do-study-act
Process improvement
Quality assurance
Quality improvement
Spread
Lani Rice Marquez, MHS, is the Knowledge Management Director for the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project at University Research Co., LLC (URC). A health management and evaluation specialist, Lani has worked for over 30 years in international health programs, where much of her work has focused on strengthening the performance of facility-based and community-based health workers in low- and middle-income countries through improvement methods. For the past 10 years, she has led URC’s efforts to apply knowledge management concepts and techniques to strengthen quality improvement program efficiency and impact.
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