Blog

  • Keeping mothers and babies in care to eliminate transmission of HIV

    Nigel Livesley

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

    My colleagues in Uganda are working with rural clinics to improve their capacity to prevent mother-to-child transmission of HIV.  Recently, we visited one rural clinic whose records showed that 177 exposed babies had been born in the clinic or had come there for care at some point in the past 18 months.  Yet only 9 had come back to the clinic in April 2013.

  • Improving uptake and retention of PMTCT services

    Rhea Bright

    Quality Improvement & Human Resources for Health Advisor, USAID Bureau for Global Health Office of Health Systems
    AIMGAPS nurse explains CHSS in Tanzania

    An AIMGAPS facility nurse explains the Community Health Systems Strengthening Model (CHSS) to her colleagues during a training session in Iringa, Tanzania, where these nurses are being prepared to serve as community QI coaches for their catchment areas.

    Photo by Rhea Bright, URC

    Under the USAID Health Care Improvement Project (HCI), my colleagues in Tanzania and I have been working with the Ministry of Health and Social Welfare (MOHSW) and EngenderHealth in the Iringa Region of Tanzania to improve uptake, retention, and the quality of prevention of mother-to-child transmission (PMTCT) of HIV services. Rather than focusing solely on improving care at one point of service along the PMTCT continuum, our improvement efforts looked at improving PMTCT services across the entire continuum of care, from the antenatal period, through the entire breastfeeding period, until the HIV status of the exposed infant is definitively determined at 11 facilities in Iringa.

    In order to address the gaps in PMTCT care that were identified at the 11 facilities, a data system was developed, quality improvement (QI) teams were formed, and facility QI teams began to track indicators for various PMTCT services that should be delivered during antenatal care (ANC), labor and delivery as well as in the post-natal/infant follow-up period.  Providers began testing changes at their respective facilities to address areas in need of improvement.  However, we noticed that some indicators improved (i.e. HIV positive pregnant women started on ARV or ART; and definite testing of the HIV exposed infant), while others lagged behind (i.e. early booking for antenatal care (ANC); male partner involvement; exclusive breastfeeding; and infant and child follow-up visits).  After providers tested several different changes at the facility level and saw little to no improvement in those indicators, it became apparent that improvement efforts would need to go beyond the facility.

  • Viewing Healthcare Locally Through a “Gender Lens”

    Caitlyn Lutfy

    WI-HER LLC
    URC Uganda staff in the gender integration training

    URC Uganda staff in the gender integration training, Taroub Faramand April 2013

    “You’re breaking a ‘gender rule’ right now by eating chicken,” said one of the male participants during the lunch break at our Gender Integration training in the URC Uganda office. In a murmur of laughter and banter, the Ugandan staff members explained that for some, it is taboo for a Ugandan woman to eat chicken. For the most part, Ugandans no longer practice the rule, though some say older relatives and a few tribes still observe the gender-related chicken restriction.

    The roles, expectations, behaviors and interactions between men, women, boys and girls are intimately tied to local people and change with time. “Gender” is a social construct shaped by these customs and perceptions. In the previously mentioned example, the male-exclusive entitlement to eat chicken as a sign of reverence interacts with other customs to shape sex disparities of power and capabilities in the society. If  the women at our training abided by this restriction, our catering would have been gender-blind and, in effect, we would have only been serving lunch to men. Women, men, boys and girls also differ in their healthcare needs and the ways they access, utilize and benefit from care.

  • Applying Quality Improvement Methods to HR Performance Management

    Maina A. Boucar

    Quality Improvement Advisor, USAID ASSIST Project/URC

    This post originally appeared on the K4Health Blog.

    Dr. Karimou Sani, former USAID-HCI Advisor Tahoua, Niger; Dr Ekoye Saidou, Director General MOH Niger; Mr. Sabou Djibrina, UASID – HCI Niger; and Lauren Crigler, USAID HCI Bethesda, USA contributed to this blog post.

    Faced by a severe shortage of health care professionals throughout Niger, the country’s Ministry of Public Health requested assistance from USAID’s Health Care Improvement Project (HCI) in 2009 to implement a program to address the health workforce crisis within the country.  In response, my team and I recognized this has an exceptional opportunity to implement a program to improve the management of human resources in selected facilities and management offices within the Tahoua Region.

    As a part of the collaborative approach we adopted, quality improvement (QI) teams tested and implemented changes within their own facilities, while simultaneously monitoring performance with QI advisors and coaches from both HCI and the Ministry of Public Health. 

    Applying improvement methods to HR performance management

    Applying quality improvement methods to HR performance management

    As Quality Improvement Advisors, we recognized the importance of supporting the facility teams in strengthening their ability to recognize where they needed to improve their performance and helping them to have confidence in managing the quality of that service within their team. In order to address areas that were in need of improvement, we determined the variables that were adversely impacting health worker performance, engagement, and productivity.  The steps we undertook to address these areas are displayed in the diagram to the right. We began by aligning and clarifying tasks, and we measured progress in performance by tracking clinical indicators. 

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