Spread of PMTCT and ART Better Care Practices through Collaborative Learning in Tanzania

The Tanzania National AIDS Control Program (NACP) and PEPFAR initiated the Partnership for Quality Improvement (PQI) in 2007 to develop and promote a harmonized quality improvement (QI) plan for antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) services countrywide. The partnership included PEPFAR’s HIV/AIDS care and treatment implementing partners, with technical leadership from the USAID Health Care Improvement Project (HCI), implemented by University Research Co., LLC (URC), and PharmAccess International (PAI).

The PQI introduced the “Improvement Collaborative” strategy to generate better care practices to improve care provided to those needing HIV and AIDS services and has developed improvement collaboratives in four regions. Collaborative improvement is built on multiple teams working on a common aim and sharing learning about what works to achieve results more rapidly.  This study evaluates peer-to-peer learning among health workers and the spread of better care practices within regions and across regions in the PQI ART/PMTCT collaboratives in Tanzania.
This cross-sectional evaluation used quantitative and qualitative methods to measure use of mechanisms for exposure and sharing of change ideas, changes implemented, and factors that facilitated or hindered sharing and uptake of change ideas. Data were collected in three regions (Tanga, Morogoro, and Mtwara) in a total of 25 sites. URC/Tanzania staff collected data through interviews and focus group discussions with team members, Council Health Management Teams, Regional Health Management Teams, implementing partners, and the NACP during the period of February to May 2010.
The evaluation found that across the three regions, the great majority of ideas were “borrowed” from other teams, indicating that ideas of other teams are the main sources of adopted changes. The most commonly used (and also the most favored methods) of presenting information about changes were oral presentations with visuals, written descriptions, provision of tool/materials, evidence on effectiveness and warnings to avoid failures. Simplicity of the change idea was most frequently listed as the most important factor to try an idea, while a perceived lack of necessity was the top reason not to try. External support was the most important factor favoring implementation, while lack of technical support was the top hindering factor.
The results of the study indicate that shared learning and spread of better care practices or effective changes is taking place both within and across the three regional collaboratives studied. Teams desired relatively detailed information about “how to do” the changes they were exposed to. Results also show that not all changes were equally spreadable; spread depended on how straight-forward was their implementation and whether it required authority or resources beyond the purview of the facility. Additional mechanisms for sharing learning across regions are needed, as well as mechanisms within regions that build on existing structures and meeting opportunities.
Report Author(s): 
Tanzania Spread Study Team
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