Stakeholders Comment on CQI Tools and Techniques
Ciheb’s continuous quality improvement (CQI) work has contributed to the development of national strategic plans and associated partnership frameworks focused on quality improvement. Over time, Ciheb specialists have worked with other experts to develop general and country-specific resources that include guides, curriculums, templates, and illustrated best practices. Now, these resources are being shared on Ciheb’s new CQI pages.
With the launch of the new pages, Ciheb invited stakeholders from Botswana and Tanzania — the first two countries with dedicated sub-pages on Ciheb’s site — to share perspectives and insights on the work being done.
Dr. Denis Mzaga, quality improvement coordinator, National AIDS Control Program (NACP), Ministry of Health, Dodoma, Tanzania
Ciheb has greatly supported QI initiatives in this country. Particularly, I am impressed by the CQI digital platform. It is a very useful tool that simplifies the implementation of QI initiatives and sharing the process and findings for easy monitoring. The tool will revolutionize how we implement QI initiatives. It will save lots of time for manually monitoring QI through paper-based tools, and it will motivate and educate care providers on how to improve the quality of services, as they will be able to access shared best practices across the country.
Though the tool is not fully scaled up, with time, its use will ultimately improve the quality of health services by helping health facilities have their own QI projects that can be viewed by others and also be closely monitored at central and national level.
Dr. Bornapate Nkomo, head of HIV programmes, Botswana Ministry of Health and Wellness
The CQI support that we have been receiving from Bummhi (the Botswana-University of Maryland School of Medicine Health Initiative) has been useful to HIV programs because after attending the CQI training, programs were able to appreciate the importance of performance improvement. Although it is still early to conclude if CQI is helping Botswana to meet its health goals, through integration and implementation of QI processes, we have noticed an increase in the number of newly HIV-diagnosed clients initiated on antiretroviral therapy (ART) on the same day or within 7 days (fast-track).
Viral load (VL) access rates have also improved due to implementation of appointment systems, a QI stepwise approach towards ensuring that we account for all our clients living with HIV when it comes to VL testing. It is hoped that such initiatives with improvements that are evident, will contribute to reduced mortality and morbidity, especially HIV-related, in the long run.
Dr. Pius Massele, regional AIDS control coordinator, Ministry of Health, Mwanza Region, Tanzania
The CQI approach that has been pioneered by Ciheb has been useful to ensure standard service delivery to our clients, as well as increasing knowledge to our healthcare workers who are now well equipped and can easily identify performance gaps and challenges, and thus implement interventions to overcome them in daily service provision.
Tools such as the data analysis companion (DAC) that Ciheb developed have been particularly beneficial. It has helped identify needed services for eligible clients during a clinic visit, which has improved indicator performance. Another important tool is the digital CQI platform, which is helping healthcare workers implement CQI approaches and track their progress across different indicators.
The tools and overall approach have been very useful in helping to meet Tanzania’s goal of HIV/AIDS control. Healthcare workers in supported facilities have been able to use the CQI approach in improving key indicator performance along the 95-95-95 cascade, which is contributing to impacts in national performance at large.
Thandi Nthokana, principal registered nurse, Nkoyaphiri Clinic, Gaborone District, Botswana
Bummhi has been instrumental in training and mentoring us on CQI. It provided us with phone and on-site mentorship, especially in the implementation of quality improvement projects. Bummhi staff are skillful and passionate about the use of data and continuously encourage us about knowing our data, discussing the data, identifying gaps, and documenting QI projects.
In 2018, the viral load (VL) access rate at our facility was 75%. Bummhi supported us to implement a project on a VL appointment system because we had no system in place to know who came for VL collection and who did not. In 2019, our VL access rate was 98%.
Another example was in December 2019 when Bummhi supported us to manage our clients with detectable VL according to the guidelines. Within three months, 62% of our clients were undetectable. Bummhi has also been instrumental in supporting us to improve same-day ART initiation of clients who are diagnosed with HIV.
Dr. Hamis Kulemba, regional AIDS control coordinator, Ministry of Health, Simiyu Region, Tanzania
Ciheb has contributed a lot to improve the quality of health services for people living with HIV in all the supported facilities in Simiyu Region. The team has extremely good and talented mentors who are full of knowledge and skills about improving HIV services.
The team has played a vital role in helping our region meets its health goals. For example, they have been very instrumental in supporting multi-month scripting (MMS) coverage and intermittent preventive treatment coverage among eligible clients. They have also improved HIV viral load coverage among eligible clients, improved enhanced adherence counselling initiation for clients with high viral load, and improved monitoring of quality improvement using the app they developed.
Regina Kimambo, senior program officer of quality improvement (QI), Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI), Tanzania
Ciheb uses QI principles and an improvement model in all of their initiatives. The team is very creative, innovative, and keen to see changes leading to the improvement of quality of care to people living with HIV.
Ciheb’s innovation helps a lot since the team is focused on the improvement of healthcare services at all levels. They are always coming up with tools to support the improvement process, which I believe will help our country achieve the UNAIDS goal of 95-95-95.
Ciheb’s innovation can be seen in the use of the DAC tool for QI analysis, sharing CQI activities and the plan-do-study-act cycles through the CQI dashboard, and QI presentations through the ECHO platform. Ciheb has also supported AGPAHI in the development of IQ SMS, a mobile application for daily monitoring of priority indicators, which makes it easy for technical staff to observe gaps on a daily basis and intervene.