ISQUA17-1913REDESIGNING THE NAMIBIAN HIV QUALITY IMPLEMENTATION MODEL TO IMPROVE QUALITY OF CARE SYSTEMS

Abstract

Introduction: The Namibia HIV quality of care (HIVQUAL) program was initiated in 2007 by the Ministry of Health and Social Services (MoHSS) to monitor and improve the quality of HIV care provided in public health facilities. 37 sites were selected to participate including all 34 hospitals and 3 healthcare centres. Quality of care indicators were selected and performance was reviewed biannually using six months' worth of data. Annual Organisational Assessments (OAs) were introduced to assess quality management (QM) structures and were to be conducted at the sites by national quality improvement (QI) team as external assessors. Peer learning networks were introduced where at the end of each performance measurement (PM) period, facility QI teams comprising of a doctor/pharmacist, nurse and data clerk would congregate to present their HIVQUAL performance reports. Sites were required to submit data to the national QI team prior to the learning network; a practice which they complied with until 2015 when several sites stopped submitting data. Furthermore due to inadequate staffing, the national QI team was unable to conduct annual OAs in all 37 sites. In addition, there was minimal consumer involvement at the sites and as well as at peer learning networks. Objectives: To restructure the Peer Learning Network model to ensure timely submission of data, conducting of annual OAs and active involvement of consumers. Methods: Restructuring of Peer learning network was initiated in January 2016 by MoHSS and relevant stakeholders who came up with a set of interventions to address the gaps. It was agreed that only sites that submitted data on time were to be invited to the peer learning sessions. In addition to site presentations on PM data, technical support was to be provided to; identify quality gaps, design and initiate QI projects. The national QI team would conduct OAs at the peer learning session since key informants were already attending the meeting instead of going to the sites. Each participating site was required to nominate a consumer to participate in the learning network. Results: PM data submission from the sites improved from 0% in October 2015 to 100% by April 2016 (n = 37 sites). The same trend continued in October 2016 PM data review period. Conducting of annual OAs improved from 0% in 2015 to 100% by September 2016 (n = 37sites). As a result, each site drafted an annual QM work plan and initiated at least one QI project. A dashboard capturing OA results and QM site plans was developed to monitor progress. Consumer involvement in learning sessions improved from no representation in 2015 to having consumer representation in 39% of sites (n = 37 sites) in 2016. Two consumer focus group discussions were conducted involving 15 consumers. Conclusion: Every system is perfectly designed to give exactly the results it achieves. Redesigning the HIV QI implementation model led to significant improvement in timely submission of PM data, conducting of annual OAs, active consumer involvement in QM activities and initiation of QI projects.