This activity will expand upon the work of HIVQUAL-MOZ which began in FY 2006 at 45 HIV treatment

centers throughout Mozambique. The HIVQUAL model is designed to integrate performance measurement

and quality improvement at the clinic level, and to develop a quality management program to support

ongoing activities.

HIVQUAL activities in HIV treatment have built capability of HIV healthcare providers to monitor the quality

of care throughout the country. In FY 2008 the program will be expanded by including quality monitoring of

PMTCT services. PMTCT expansion will occur in four sites. This service represents a unique challenge

because quality depends on coordination of services with other agencies and linkages to other services.

In FY08, the PMTCT expansion of HIVQUAL-MOZ will continue to be executed under the leadership of the

Ministry of Health in close collaboration with CDC-Mozambique and the US-based HIVQUAL team for

technical support. Activities will include: 1) Quality improvement (QI) training of providers and program staff;

2) assessment of quality management programs at the participating clinics; 3) performance measurement

(at six month intervals) of selected core indicators; 4) ongoing quality improvement coaching to participating

sites; 5) promotion of consumer engagement in HIV services; 6) regular conference calls with the US-based

team. Data analysis and planning for expansion based on the results of the pilot will also occur.

Activities will result in strengthening PMTCT systems, including strategic information and service delivery in

health service agencies and clinics. The emphasis of this method is to develop provider skills for using

performance data within their organizations, for the specific purpose of driving improvements within their

own service points. Training will also be provided to key MoH staff at the provincial level as indicated.

In FY08, HIVQUAL indicators will be devised for the PMTCT program. Cooperation with implementing

partners, other donors, WHO and UNICEF will occur so that a participatory process is implemented for

indicator development.

The specific emphasis of this activity is at the clinic or agency level, adapting the methods of quality

improvement to each organization's particular systems and capacities. An assessment tool to measure the

capacity of the quality management program at each facility will be used to measure the growth of quality

management activities as well as to guide the coaching interventions.

Facility-specific data that are aggregated can provide population-level performance data that indicate

priorities for national quality improvement activities and campaigns. Publication and dissemination of these

data will be done under the auspices of the MoH.

The unique approach of HIVQUAL-MOZ is that it targets regional networks of providers who are engaging in

quality improvement activities that enables them to work together to address problems that are unique to

each area, including, for example, human resource shortages and coordination of care among multiple

agencies as well as adherence to care services. Quality improvement training will be conducted for groups

of providers. The project will work in partnership with all PMTCT partners who will help disseminate quality

improvement strategies and activities throughout their networks.

The USG HIVQUAL team will expand its focus to build quality improvement coaching skills among MoH

staff and providers in Mozambique, and provide advanced level trainings for sites as well as basic trainings

for new participants. The training activities will be done in collaboration with JHPIEGO and the University of

Pittsburgh through subcontracts with the New York State AIDS Institute funded through USG/HRSA.

Funding for these expansion activities will benefit from economy of scale since HIVQUAL-MOZ has already

been supported for implementation in adult care and treatment facilities. Additional funds for these activities

will be used to support additional specific activities and travel to PMTCT sites, development of program-

specific materials, and engagement of consultants with expertise in this field, especially implementation of

services in systems of care providing services to mother-infant pairs from diagnosis to initiation of

antiretroviral therapy if needed.

This activity will expand upon the USG support of HIVQUAL-MOZ which began in FY06 to improve

capability of HIV healthcare providers to monitor the quality of care in 45 HIV clinics throughout the country.

The HIVQUAL model emphasizes integrating performance measurement and quality improvement, and

developing a quality management program to support activities at the clinic level. In FY08 the program will

be expanded by including quality monitoring of Counseling and Testing (CT) services in three selected pilot

sites.

The national CT expansion strategy has undergone some major changes which aside from greater

emphasis on expansion of Provider Initiated CT (PICT), and the implementation of first pilot experiences in

Community-based CT (CCT), a new approach has been promoted and piloted in three sites in Maputo City.

The "CT in Health" (CTH) approach was promoted by the Health Minister in 2006 as a way to implement

health promotion and prevention activities aiming at enhancing the number of people that access health

services. This health promotion package proposes continuation and expansion of HIV counseling and

testing as well as the inclusion of TB, Sexually Transmitted Diseases (STD) and hypertension screening

and referrals where necessary, counseling on malaria prevention, environmental health education, and

sexual reproductive health orientation - especially in relation to early pregnancy diagnosis and institutional

delivery. One of the results of the CTH pilot was an increased number of HIV-negative clients screened for

TB, STDs and hypertension and referred to services when necessary for early diagnosis, care, and

treatment related to these diseases.

In FY08, the continuation and expansion of HIVQUAL-Mozambique will continue to be executed under the

leadership of the Ministry of Health (MOH) in close collaboration with CDC-Mozambique and the US-based

HIVQUAL team for technical support. HIVQUAL indicators will be devised and extended to include CT

program indicators. Cooperation with implementing partners, other donors and WHO will occur so that a

participatory process is implemented for indicator development. Activities will include: 1) Quality

Improvement (QI) training of CT providers and program staff; 2) assessment of quality management

programs at the participating CT sites 3) performance measurement (at six month intervals) of selected CT

core indicators; 4) ongoing quality improvement coaching at participating CT sites; and 5) promotion of

client engagement in HIV Care. Data analysis and planning for expansion based on the results of the pilot

will also occur. Activities will result in strengthening CT services delivery through improved information

available on potential gaps and opportunities for improving the quality of CT services. The emphasis of this

method is to develop skills for use of performance data by providers within their settings and for the specific

purpose of driving improvements in their systems of care. Quality improvement training will be conducted for

groups of CT providers and to key MOH CT staff at the provincial level. The HIVQUAL team will expand its

focus to build quality improvement coaching skills among MOH CT staff and CT providers in Mozambique,

and provide advanced level trainings for sites as well as basic trainings for new participants. The training

activities will be done in collaboration with JHPIEGO and the University of Pittsburgh through subcontracts

with the New York State AIDS Institute funded through USG/HRSA. This project will work in partnership with

all CT partners in Mozambique who will help disseminate quality improvement strategies and activities

throughout their networks.

Funding for these expansion activities will benefit from economy of scale since HIVQUAL-MOZ has already

been supported for implementation in health care facilities. Part of the funds will be used to support

additional specific activities and travel to CT sites, development of program-specific materials and

engagement of consultants with expertise in these fields.

This is a continuing activity from FY07.

The goal of HIVQUAL-MZ is to allow individual health care providers to engage in a participatory process of

quality improvement based on evidence and data collected locally by their own teams. Using the HIVQUAL

model, Health Units, Districts, Provinces, and the MoH at the central level gauge the quality of the health

services provided to HIV-positive persons using indicators based on national guidelines, and propose

feasible and sustainable strategies to improve the quality through implementing established standards of

care and treatment.

Established indicators measured through HIVQUAL-MZ determine the level of continuity of care, access to

antiretroviral therapy and CD4 monitoring, TB screening, prevention education, adherence assessment, and

PEP implementation. The specific focus of this activity is at the clinic level, adapting the methods of quality

improvement to each facility's particular systems and capacities. An assessment tool to measure the

capacity of the quality management program at each clinic is used, and measures the growth of quality

management activities as well as guides the coaching interventions. Facility-specific data that are

aggregated provide population-level performance data that indicate priorities for national quality

improvement activities and campaigns.

The unique approach of HIVQUAL-MZ is that it targets regional networks of health care providers who

engage in quality improvement activities to address problems that are unique to each area, like human

resource shortages, coordination of care among multiple agencies, and adherence to care services. Quality

improvement training is conducted for groups of providers, who help disseminate quality improvement

strategies and activities throughout their networks.

This activity will continue to expand upon the work of HIVQUAL-MZ, which initially began in FY 2006. In FY

2007, the program a) met with the seven implementing partner agencies to introduce HIVQUAL-MZ, b)

recruited a Mozambique Project Lead in collaboration with JHPIEGO, c) received official approval from the

MoH, d) selected performance indicators for Year 1, e) engaged and selected 34 pilot sites with the partner

agencies, f) conducted initial site visits with organizational assessments, g) finalized data collection tools

including the HIVQUAL-MZ software, h) conducted software, performance measurement, and quality

improvement training sessions with the partner agencies, and i) trained the Provincial Medical Coordinators

in quality management including the HIVQUAL-MZ module.

Using FY 2008 funds, HIVQUAL-MZ activities will include a) conducting site visits to and organizational

assessments of all 70 pilot sites (36 new sites will be added to the original 34 sites), b) orienting the

Provincial Health Officials, c) completing the first baseline data submission and report, d) convening the

regional networks to initiate their quality improvement projects, and e) completing the second data

submission and report.

FY07: This activity is linked to activities 8593, 8574, 8580, and 8545.

This activity will expand upon the HIVQUAL-MZ work which began in FY 2006 to reach (South and Center)

at 10 sites. In FY 2007 the program will be expanded to 6 new sites in the northern region and an additional

10 sites in the southern and center regions.

The goal of HIVQUAL is to allow health services and individual health care providers to engage in a

participatory process of quality improvement based on evidence and data collected locally by their own

teams.Using the HIVQUAL model, Health Units, Districts, Provinces and the Minstry of Health (MoH) at

central level will be able to gauge the quality of services provided to the HIV+ population using indicators

based on national guidelines and to propose feasible and sustainable strategies to improve quality through

implementation of these established standards of treatment and care.

Established indicators measured through HIVQUAL-MZ determine the level of continuity of care, access to

antiretroviral therapy and CD4 monitoring, TB screening, prevention education, adherence assessment and

PEP implementation. The specific emphasis of this activity is at the clinic-level, adapting the methods of

quality improvement to each organization's particular systems and capacities. An assessment tool to

measure the capacity of the quality management program at each facility is used and will both measure the

growth of quality management activities as well as guide the coaching interventions. Facility-specific data

that are aggregated can provide population-level performance data that indicate priorities for national quality

improvement activities and campaigns.

The unique approach of HIVQUAL-MZ is that it targets regional networks of providers who are engaging in

quality improvement activities that enables them to work together to address problems that are unique to

each area, including, for example, human resource shortages and coordination of care among multiple

agencies as well as adherence to care services. Quality improvement training will be conducted for groups

of providers. The Project will work in partnership with all treatment partners who will help disseminate

quality improvement strategies and activities throughout their networks.

The USG HIVQUAL team will expand its focus to build quality improvement coaching skills among MOH

staff and providers in Mozambique and provide advanced level trainings for sites as well as basic trainings

for new participants. Mentoring of MZ-based staff will continue throughout the activity. Work will continue

in partnership with the University of Pittsburgh and with JHPIEGO, which has recruited the project manager

and provides logistical coordination for activities. Working with JHPIEGO facilitates the coordination of

other QI activities in Mozambique which address infection control practices. One of the goals for 2007 will

be to identify a lead staff person in the MoH to assume direction for the project. Travel funds for this

individual to the US for an intensive mentoring program in New York and Pittsburgh is included.

Additional staff for the activity will be recruited as necessary although efforts will be directed to promote

sustainability through building capacity for management in direction within the MoH.