Ciheb Tanzania Toolkit

The guide is informed by UMB’s and Ciheb’s collective CQI implementation experience over a nearly 15 year period across six low-resource countries and has been adapted to the Tanzania context. Stakeholder engagement has been emphasized throughout the application of our CQI approach to ensure buy-in to the assessment, implementation process, monitoring of CQI initiatives, and sustainability for maintenance.

Below, we share evidence-based resources developed to support the implementation of quality improvement projects. Included in the materials are valuable external resources that our teams have utilized for successful implementation of CQI. We also recommend the Aurum Institute's How to Guide for Quality Improvement, which is an easy-to-read guide and provides examples and methods for administering quality improvement.

Step 1: Conducting a rapid assessment of the facility through review of data and process mapping

• Activity 1: Engage leadership within an organization for support and buy-in.
  Tools: CQI Plan Template
• Activity 2: Conduct joint rapid assessment of services and review the findings.
  Tools: Organizational Assessment Tool
• Activity 3: Identify a CQI team to drive the CQI and planning processes.
  Tools: Knowledge and Skills Assessment Tool
• Activity 4: Develop QI skills for the team.
  Tools: CQI Meeting Template

Step 2: Identification of the opportunity for improvement

• Activity 5: Conduct a root-cause analysis to identify the problem, e.g., fishbone and five whys.
  Tools: Example of Fishbone Diagram (blank), Fishbone Diagram, Example of Five Whys
• Activity 6: Characterize and contextualize the gap using available data or proxy measures.
  Tools: PDSA Template, PDSA Worksheet, Client Triage Checklist

Step 3: Planning and prioritizing

• Activity 7: Use priority methodology, e.g., QI prioritization matrix.
  Tools: Prioritization Matrix
• Activity 8: Prioritize interventions depending on gap and other contextual factors to determine the change package. Tools: Driver Diagram Example, Driver Template, CQI Change Package
• Activity 9: Identify the benchmark and indicator selected for improvement.
  Tools: CQI Indicators

Step 4: Implementing QI approaches: monitoring, collaborative learning, and scale up

• Activity 10: Record the CQI plan in the CQI digital app.
• Activity 11: Continuously monitor and update progress/challenges in the CQI digital platform.
• Activity 12: CQI teams participate in regular (quarterly) peer-based learning forums (collaborative learning forums).

Step 5: Dissemination

• Activity 13: Identify options for formally presenting CQI initiatives and the role of stakeholders in dissemination.