• What did APHA offer this year?

    Kim Ethier Stover

    Senior Improvement Advisor, USAID ASSIST Project/URC

    When you attend a meeting with over 13,000 people with activities spread over seven days and a conference program the size of a phone book, you can’t help but have the overwhelming feeling that you missed more than you saw.  I attended two days of the meeting, November 4th and 5th.  I was lucky enough to have an oral presentation on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project at 8:30am on November 4th in a session titled “Implementation strategies for adapting global tools, knowledge, and

  • Focusing on the person, not the problem

    Nigel Livesley

    Regional Director for South Asia, USAID Applying Science to Strengthen and Improve Health Systems (ASSIST) Project, University Research Co., LLC (URC)

    I really like this case study by Tiwonge Moyo because it highlights the importance of focusing on the person not on the problem.  Many aid projects come in with a set of solutions for specific problems.  For example, education projects may give school materials to improve education or nutrition/livelihood projects may provide animals to improve economic security.  The needs of people and communities, though, are usually more complex and single solutions may not always work. 

  • Quality Improvement and Human Resources Management Enhances HIV Services in Tanzania

    Macdonald Kiwia

    Quality Improvement Advisor, USAID ASSIST Project/URC

    This post originally appeared on the K4Health Blog.

    Dr. Stella Mwita, Dr. Yohana Mkiramwene, Kim Ethier Stover, and Tana Wulji, Quality Improvement Advisors working with USAID’s Health Care Improvement Project (HCI) in Tanzania, also contributed to this blog.

    We are the Quality Improvement Advisors to University Research Co., LLC, in Tanzania. In this role, we support the Tandahimba District in Mtwara Region in combining improvement and health workforce development approaches through the Tanzania Human Resources for Health Quality Improvement Collaborative. Our efforts aim to improve anti-retroviral therapy and prevention of mother-to-child transmission care.

    A quality improvement team develops a process map on enrollment in HIV treatment at Tandahimba District Hospital, Mtwara, Tanzania

    A quality improvement team develops a process map on enrollment in HIV treatment at Tandahimba District Hospital, Mtwara, Tanzania. 

    Photo by Yohane Mkiramweni, URC.

    The Tandahimba District has a severe shortage of health care workers in most of its health facilities. Rather than trying to add more health workers, USAID, HCI, and the Ministry of Health (MOH) decided to focus on maximizing the productivity of the few existing staff.  We expected that improved productivity might cover the service gaps created by the shortage of health workers.  Our work in Tanzania is adapted from HCI’s successful experience in Niger, where teams improved productivity, engagement, and clinical outcomes by combining human resources interventions and improvement approaches. 

  • Community leaders at the helm of improvement

    Tiwonge Tracy Moyo

    Chief of Party, Malawi, USAID ASSIST Project/URC

    Most organisations working with communities collaborate with government line ministries at a particular time depending on the type of activity being implemented. What I value in the Blantyre story is the pivotal role the multi-sectoral QI team is performing to improve vulnerable children’s wellbeing at the community level. All the members of the team bring some knowledge, skills and experiences to support young children to thrive in their holistic development.

  • Health Care Improvement Project’s CHW AIM Tool Strengthens Community Health Worker Programs

    Donna Bjerregaard

    Senior Technical Advisor, Initiatives Inc.

    This post originally appeared on the K4Health Blog.

    The global shortage of health workers has created cracks in the bridge to health services for Africa’s communities. Many countries and donors are looking toward community health workers (CHWs), who have a vested interest in the health of their communities, to fill the gaps.  Although CHWs have played a role in prevention and care for over 50 years, we have not had a way to evaluate whether the programs are meeting communities’ needs. We also don’t know the level of support CHWs receive to help them provide quality services. 

    A community health worker in Dhaka, Bangladesh, follows up on a child with fever

    A community health worker in Dhaka, Bangladesh, follows up on a child with fever.

    It was this thinking that led Initiatives Inc. and the USAID-funded HCI Project to develop the Community Health Worker Assessment and Improvement Matrix (CHW AIM). Through a literature review and repeated testing, 15 components of a well-functioning program emerged, ranging from recruitment and training to community involvement and country ownership. 

    We designed the process to be used by program managers, CHWs, donors, and stakeholders. Led by a facilitator, the group engages in discussions about where they stand on each programmatic component on a scale from 0 (non-functional) to 3 (highly functional or best practice). In many cases, this is the first time ideas are shared from so many different perspectives. This can lead to awareness and sometimes confrontation, but the process also creates understanding and builds team spirit and commitment to improve. The group builds an action plan for the changes needed based on the assessment. Sue England of World Vision Australia observed, “The tools make it clear to all participants that we are assuming a lot and that’s why many programs fail.”