08.X1310: HIVQUALH - HIV Quality Assurance

The HIVQUAL program in Botswana will be executed under the leadership of MLG and in close

collaboration with HHS/CDC/BOTUSA for program management and technical support. This activity

complements other quality assurance activities supported by the USG in Botswana, focusing on facility-level

data collection and data management, feeding directly into these other activities for monitoring and

evaluation and quality assurance, under the stewardship of the MLG.

The HIVQUAL philosophy is based on the concept that quality management programs should reflect a

balance between quality improvement and performance measurement and be built upon a foundation of

programmatic support and infrastructure. This organizational approach to quality management emphasizes

the development of systems and processes to support quality improvement activities involving clinic staff

and consumers with support from agency leadership. These structural features are designed to be

sustainable even when staff turnover is high or organizational affiliations change.

Four principles guide the methodology of the HIVQUAL Project: 1) ongoing quality improvement activities

improve patient care; 2) performance measurement lays the foundation for quality improvement; 3)

infrastructure supports systematic implementation of quality improvement activities; 4) indicators to measure

performance are based on clinical guidelines or formal group decision-making methods.

The program will be piloted in a sample of 12-20 clinics and hospitals providing HIV care and ART,

encompassing a diversity of care models and patient load sizes. Capacity-building will involve building skills

for a) data management focusing on clinical information; b) chart abstraction or use of existing databases.

Quality improvement trainings will be conducted with interactive sessions involving hands-on application of

QI tools and techniques that are immediately transferable to the clinic setting. Organizational assessments

are conducted of the facility-based quality management program to facilitate development and

implementation of processes and structures that will support sustainable ongoing quality management.

Activities will result in strengthening systems for documentation of clinical care.

Ministries will use data to develop a national quality management plan to champion quality, monitor

performance among HIV clinics and districts through development of benchmarking reports, development of

capacity for conducting QI training and promoting sharing of best practices and regional quality

management groups for developing a sustainable network of quality management.

USG funding will support travel of the US team for mentoring of in-country program staff and to coach the

team in provision of technical assistance to providers. Training will be provided as well as study-tour to the

US for the national HIVQUAL team.