Using a Quality Improvement Approach to Strengthen Clinical Zika Services: Head Circumference Measurement and Provider Perceptions in Peru
Though rates of Zika infection are now declining, USAID, the international community, and country governments continue to respond to Zika infection in the Latin American and Caribbean Region. The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has worked to strengthen the capacity of Ministries of Health to provide quality Zika care to reproductive age and pregnant women and newborns. ASSIST’s work to enhance Zika care included: improving delivery of Zika prevention messages, providing condoms to pregnant women to prevent Zika infection, developing and supporting standardized processes for Zika screening, referring suspected cases for further investigations, diagnosing and improving clinical care and follow-up for infants affected by Congenital Syndrome associated with the Zika virus, and providing psycho-social support to mothers, partners, and families. As focus on increasing the knowledge of providers through training alone does not produce the expected changes in provider behavior, ASSIST sought to improve Zika care through the addition of quality improvement (QI) interventions to training.
QI is a data-driven approach to identify and address gaps in health care service quality, however there is limited data on its effectiveness and cost-effectiveness. ASSIST worked with the regional health authorities of Peru to develop and strengthen QI efforts in the Tumbes and Piura regions between July 2018 and July 2019. In addition to training antenatal and newborn care providers on Zika care, ASSIST implemented QI activities using multi-facility improvement collaboratives including national-level planning visits, formation of the ASSIST Peru team, QI curriculum review, training facilitators and QI teams, and health facility visits. This study sought to assess whether the ASSIST Zika QI approach was associated with improvement in specific Zika-related processes of care such as head circumference measurement and documentation among health workers providing antenatal and newborn care in Peru and to identify providers perceptions of the benefits of QI for improving Zika clinical care.