Short Report

Improving Access to HIV Testing and Treatment Services for Vulnerable Children and their Caregivers in Uganda

In October 2015, following the PEPFAR guidance to improve integration of HIV and OVC care programs for improved outcomes for children and their caregivers, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project set out to support OVC implementing partners (IPs) to strengthen community-facility linkages. To commence this work, ASSIST worked with 10 CSOs that were selected by the IPs in 38 villages in 6 districts.

ASSIST supported the setup of QI teams at the parish and CSO levels. ASSIST also built the capacity of these CSOs to conduct quality supervision. ASSIST used a collaborative approach where we set QI teams at the different levels: CSO and community given that they were both working on different processes of the community-facility linkages. The work started with the CSOs focusing on increasing the proportion of supported beneficiaries (vulnerable children and caregivers) with a known HIV status, then they began identifying HIV positive children in the supported communities who had not yet been reached by their programs. Subsequently, their efforts targeted closing gaps in the processes along the HIV care and treatment cascade ensuring identification, linkage, retention, and viral suppression. To increase HIV testing among OVC program beneficiaries, teams conducted targeted home visits to provide counseling on benefits of HIV testing and conducted targeted community HCT outreaches for the beneficiaries. The find new HIV positives, teams used case finding criteria to identify new HIV positive suspects by community resource persons and provided referrals for HIV testing to the nearest health facility, outreach post and home-based HCT was conducted.

Following implementation of the changes, the percentage of vulnerable children (0-14 years) with a known HIV status increased from 37% in October 2016 to 78% in July 2017 at 10 CSOs. And OVC 15+years with caregivers improved from 35% to 81%. Changes tested include: targeted home visits to provide counseling on benefits of HIV testing and targeted community HCT outreaches. Similarly, the percentage of persons eligible for HIV testing who tested HIV positive reached an average of 54% for children (0-14), adolescent 15+ years, and caregivers by July 2017. Those eligible were identified through use of a screening tool (Appendix I) with children 0-14 as an entry point to the household. On identification of eligible persons for HIV testing, 5community resource persons made referrals to the nearest health facility, outreach testing points, and, in some cases, home-based HCT. Referrals were done with the MGLSD referral form (Appendix II).

This change package illustrates how to improve processes of care for HIV-positive children (including identification, linkage to care, and viral suppression) in the community. It serves as a learning tool for organisations, CSOs, or local government Community Development Officers and any other entities working in the community that can adapt or adopt these suggested solutions to their own settings. The change package includes a “how to” section with detailed explanation of the implementation of the change ideas. Teams may select what they deem as relevant changes, adapt or adjust them as necessary, then test them on a small scale and use data to determine whether implementing those ideas has led to improvement or not. The team should continue testing or adding ideas until the desired level of performance is reached. It is important to note that the improvement teams need to understand the root cause of the challenge they are trying to address to be able to identify an effective change that will close the gaps.

Inicia la capacitación en apoyo psicoemocional a proveedores de salud

La Secretaria de Salud de Honduras (SESAL), con el apoyo técnico y logístico del Proyecto ASSIST de USAID, ha elaborado un plan de capacitación con las herramientas necesarias para capacitar en como brindar apoyo psicoemocional a todo el personal en contacto con mujeres embarazadas, madres de recién nacidos y familias afectadas por el Síndrome Congénito asociado a Zika.

Un primer taller se llevó a cabo en el mes de abril del 2018 con psicólogos procedentes de cuatro regiones de salud con quienes se discutió y validó el contenido del documento base de apoyo psicoemocional y el proceso de capacitación. Es objetico del taller desarrollar las habilidades de comunicación en el personal de salud para informar a las familias afectadas las noticias adversas sobre el estado de salud de sus hijos y realizar la referencia correspondiente a los servicios de psicología.

Este artículo describe el taller y comparte presentaciones abordando los temas siguientes:

  1. Como informar malas noticias
  2. Como reconocer las reacciones de las usuarias y de las familias
  3. Intervención en crisis
  4. Cuidando al cuidador
  5. Adaptación a la separación

The Ministry of Health of Honduras (SESAL), with technical assistance from ASSIST, has developed a training plan with tools to train frontline providers in how to provide psycho-emotional support to pregnant women, mothers of newborns and families affected by the Congenital Syndrome associated with Zika.

A workshop was held in April 2018 with psychologists from four health regions to discuss and validate the content of the psycho-emotional support technical document and training process. An objective of the workshop was to develop the communication skills of health personnel when delivering bad news about the health status of their children to families and to train them to make the appropriate referrals to psychology services.

This article describes the workshop and shares presentations on the following topics:

  1. How to give bad news
  2. How to recognize the emotional reactions of patients and families
  3. Crisis intervention
  4. Caring for the caregiver
  5. Dealing with loss

Strengthening Governance to Improve the Quality of Health Service: A Consensus Statement

This Consensus Statement on Strengthening Governance to Improve the Quality of Health Service Delivery provides guidance to policy-makers, government ministries, the global health community, front-line health workers, and the general public on the importance, challenges and opportunities for strengthening governance to improve quality of health care. It documents the journey of governing for improvements in health outcomes and proposes priority actions to establish and improve governance strategies, actions, and roles and relationships to strengthen health quality.

The statement calls on governments, the private sector, global organizations, and development partners to strengthen governance—including the transparency, accountability, and responsiveness of health care delivery—to assure and improve quality, through key investment priorities.

The statement was conceived and drafted by participants at the 2nd Governing to Improve Quality Workshop (August 9-11, 2017) with inputs provided by a virtual community of practice for governance for quality health care comprised of 14 country representatives from development partners and international institutions. The final statement was developed by the USAID Health Finance and Governance with support from ASSIST and participation from the Joint Learning Network.

Read the full statement.

Mejorando la prevención, la atención y el apoyo relacionados al Zika para los infantes afectados y sus familias

In English

Como parte de la respuesta de USAID ante el brote de Zika, ASSIST ha venido implementando esfuerzos para fortalecer los sistemas de salud en Latinoamérica y el Caribe, proporcionando apoyo focalizado a aquellos sistemas afectados por el virus del Zika.

ASSIST trabaja para mejorar la capacidad que tienen los servicios de salud relacionados al Zika de proveer atención consistente, basada en evidencia, respetuosa y de alta calidad, con énfasis en mujeres embarazadas, recién nacidos y mujeres en edad fértil.

Aprender más sobre nuestras actividades en Zika:

Improving Zika Prevention, Care, and Support for Affected Infants and Families

En español

As part of USAID’s Zika response, ASSIST has been implementing health systems strengthening efforts in Latin America and the Caribbean to provide targeted support to health systems affected by the Zika virus.

ASSIST is working to improve the capacity of Zika-related health services to deliver consistent, evidence-based, respectful, high-quality care—with a focus on pregnant women, newborns, and women of reproductive age.

Learn more:

Increasing Accountability for the Reliability of Rapid HIV Test Results: Observations from Seven Facilities in Rungwe District Council, Tanzania

In Tanzania in 2015, the USAID ASSIST project in collaboration with the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) and implementing partners (IPs) was tasked to support activities to improve the quality of HIV rapid testing at point-of-care testing sites in 27 PEPFAR scale-up saturation districts of the Tanzania mainland under the regional HIV rapid testing quality improvement initiative (RTQII). 

In 2015, ASSIST supported the Regional Health Management Team (RHMT) of Dodoma Region and the Dodoma Municipal Council to conduct HIV testing services quality assessments and coach health workers in 16 facilities on HIV testing services (HTS) quality improvement (QI). In July-September 2016, ASSIST supported the MOHCDGEC to carry out a baseline quality audit in 485 rapid testing points in 204 health facilities in 22 of the PEPFAR scale-up saturation districts and subsequently was asked to support improvement activities for rapid HIV testing in three regions: Mbeya and Rungwe district councils in Mbeya Region, Arusha Region, and Nyamagana Municipal Council in Mwanza Region.

This technical report describes the HIV rapid testing QI support that ASSIST provided in Rungwe District Council, where the project supported the Rungwe Council Health Management Team (CHMT) and IPs to instigate improvement efforts in 22 rapid HIV testing points at seven health facilities.  The rapid testing points, which are outside the traditional laboratory-based testing process, included point-of-care rapid HIV testing at prevention of mother-to-child transmission (PMTCT), voluntary counseling and testing, tuberculosis/HIV, and sexually transmitted diseases clinics.

During the course of this intervention, it was found that blending quality assurance, QI problem solving processes, use of a focal person, and engaging leadership in QI activities not only increases accountability for the reliability of the HIV rapid testing results, but also improves morale and commitment of HIV rapid testing providers and empowers them to take responsibility for improving the quality of services they provide. Through the QI methods and the use of focal persons, the HIV rapid testing providers are now able to improve quality of HIV rapid testing through daily review of their performance and identify areas for improvement.

This report includes tools used by teams including a list of roles and responsibilities of an HIV rapid testing focal person and a site monitoring checklist.

Improving availability of human resources for health, essential medicines and supplies by district leaders using QI methods: Tested changes implemented in six districts of Uganda

In January 2017, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project, in partnership with the Ministry of Health (MOH), African Center for Global Health and Social Transformation (ACHEST), Uganda Management Institute (UMI), began implementing the Leadership for Quality Improvement Initiative in the six Ugandan districts of Kaliro, Kiruhura, Mbale, Ngora, Lamwo, and Lira. One of the objectives of the initiative is to enhance the capacity of district political and administrative leaders in stewardship, leadership, and governance of district health services for improving quality of health services in Uganda with focus on improving availability of human resources for health, essential medicines, and supplies.

This change package describes successful changes (actions taken) the QI teams in the six districts implemented to improve the availability of human resources for health by reducing health worker absenteeism and improve availability of essential medicines and supplies. This change package provides details on how to implement each change.

Strategies to Increase Identification of HIV Positive Children: A Compilation of Successfully Tested Changes in Communities and Health Facilities in Uganda

Identifying and diagnosing children as HIV-infected is the first step in the continuum of pediatric care and treatment. As part of its contribution to the UNAIDS first 90 goal to have 90% of all HIV infected people diagnosed, the USAID ASSIST, with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) works with the Ministry of Health (MOH) and implementing partners to test innovative approaches for increasing identification of HIV positive children and their caregivers. Following the HIV Continuum of Response (COR) model developed by ASSIST, all children and adults identified as HIV positive should be linked for HIV care and treatment. In October 2013, USAID ASSIST together with the regional implementing partners in East Central and South West regions identified eight health facilities and eight Civil Society Organizations that care for orphans and vulnerable children to test strategies to increase identification of HIV positive children. This change package highlights change ideas compiled by health facility and community QI teams to achieve two aims: 1) improve identification of HIV positive vulnerable children and their caregivers; and 2) improve enrolment of the vulnerable children and their caregivers identified as HIV positive. It provides detailed guidance that other health care providers and community organizations can use to improve identification and enrolment into care of HIV positive vulnerable children.

Improving education performance in primary schools in Malawi

Community QI teams worked with 20 rural primary schools from Balaka and Mangochi districts to improve termly academic performance of vulnerable children attending primary schools. The teams found that vulnerable children face many barriers to academic success, ranging from food scarcity at the household level, lack of scholastic materials, limited parenting skills, and scarcity of positive role models in the communities for children to emulate. These barriers result in poor education outcomes among children who drop out of school, particularly girl children.  The community teams identified a number of changes that led to improvement in outcomes and these changes have been compiled in this change package, with detail on how teams tested the changes so others may replicate these efforts.