Institutionalizing quality improvement in Cote d'Ivoire
What is institutionalization of quality improvement (QI)?
Institutionalization of quality improvement is a continuous process in which the activities related to the meaning, measurement, and quality improvement are officially and theoretically integrated to the structure and functionality of an organization of a health system (QI Project 2002).
What led the institutionalization process in Cote d'Ivoire?
Since 2003, URC has been implementing improvement projects (under HCI and USAID ASSIST) that have made it possible to obtain expertise in quality improvement in the various phases of implementation, initiation of sustainability activities and scale-up of activities. As such, the issue today is not so much a technical question, but rather how to "execute" QI activities. It is a question about how to establish and maintain QI and ensure that it continues to be a full and sustainable part of the health system in Cote d'Ivoire, inseparable from the fabric of everyday activities and routine.
What methodology and steps have been adopted?
With the leadership from the Directorate of Hospital and Proximity Medicine (DMHP), to which we have provided technical assistance, we conducted the process of institutionalization by drafting the National Policy for Quality Improvement in Health Care Services. In effect, the missions of this Directorate within the Ministry of Health and Public Hygiene (MSHP) are to define and enforce standards and guidelines for the organization of hospital care and to support hospitals in the implementation of quality standards.
What steps have we followed to develop the (PNAQSS) document?
The preparation stage consisted of putting a Technical Working Group (TWG) in place, implement a document review, and a situational analysis of all quality improvement activities in Cote d’Ivoire. After the preparatory stage, the development of the PNAQSS consisted on of a workshop consisting of national experts involved in quality of care treatment services to discuss and create the first draft of the document. This first draft was then validated at a worship chaired by the Minister of Health, along with all stakeholders (WHO, UNICEF, UNFPA, JIHPIEGO, JICA, PARSSI, etc.). This culminated in its presentation by a USAID Cote d’Ivoire representative to the Minister of Health and Public Hygiene.
What are some of the lessons learned?
As a priority of the Ministry of Health and Public Hygiene, health care quality improvement has fostered leadership and ownership throughout the institutionalization process. We have also learned that identifying the DMHP as a leader, in charge of quality management within the MSHP, has facilitated ownership. Establishing a Technical Working Group led by the DMHP made it possible to mobilize all the players in this group during the process of developing and enriching the diagnosis of quality improvement in Cote d’Ivoire. Further, the proposal to create a rough draft based on the round-table discussion made it possible to accelerate the preparation process. In conclusion, the presentation of this policy document on quality improvement and its byproducts (strategy and operational plan) can be used as a catalyst to mobilize resources of the DMHP and to ensure its implementation.
The National Policy for Improving Quality of Health Care and Services (PNAQSS) can be accessed here (in French).