This new activity will support US-based HIVQUAL Consultants to continue their work with the Namibia in-

country HIVQUAL team. The cost of this activity is split 1/3 with basic care and 2/3 ARV treatment services.

This activity will expand on the HIVQUAL work which began in Namibia in COP 2007 to reach 16 ART sites.

In COP 2008 the program will add 18 new sites throughout all 13 regions to reach all the 34 public and faith-

based district hospitals. In addition, at least five health centers will be targeted during 2008. Initially these

will be identified because of their proximity to participating hospitals.

HIVQUAL aims to provide a framework for health services staff and individual health care providers to

engage in a participatory process of quality improvement (QI) based on evidence and data collected locally.

Using the HIVQUAL model, facilities will be able to gauge the quality of services provided to the HIV+

population at increasingly higher levels using indicators based on national guidelines. Data will inform

feasible and sustainable strategies to improve quality.

In COP 2008, the activity will be conducted under the leadership of the MOHSS Directorate of Special

Programs (DSP) in close collaboration with CDC-Namibia and the US-based HIVQUAL team for technical

support. Activities will include: 1) QI training; 2) assessment of quality management programs at the

participating clinics; 3) performance measurement (at six-month intervals) of selected core indicators; 4)

ongoing QI coaching at participating sites; 5) promotion of consumer engagement in HIV care 6) regular

conference calls with the US-based team. Data analysis and planning for expansion will also occur.

Activities will result in strengthening systems of care and documenting strategic information in health care

facilities. An important emphasis of this approach is to develop providers' skills for collecting and using use

of performance data within their own organizations to improve their systems of care. Use of facility-level

data derived from the national health information system for the purpose of improving quality is an important

goal of HIVQUAL. Training will also be provided to key MOHSS staff at the national, regional, and site level

as indicated.

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

antiretroviral therapy and CD4 monitoring and access to key elements of the preventive care package and

prevention with positives interventions, including TB screening and prevention, prevention education,

adherence assessment, PCP prophylaxis, weight monitoring, food security and alcohol screening. In

COP08, HIVQUAL indicators will also be devised and extended to include PMTCT and Pediatric ART

programs.

HIVQUAL is uniquely facility and region-specific. At the clinic level, QI methods can be adapted 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 it both measures the growth of quality management

activities as well as guides 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 MOHSS.

Regionally, networks of providers who are engaging in quality improvement activities can 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 concept of quality improvement using the HIVQUAL model is still relatively new in Namibia.

Consequently, a lot of advocacy and training will need to be done in order to increase awareness and buy-in

of the initiative by health care providers. Advocacy material for quality improvement will be printed and

disseminated to health care facilities. The bulk of these activities will be undertaken within COP 07 and

continued in COP 08.

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

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

new participants. The training activities will be done in collaboration with I-TECH. Mentoring of Namibia-

based staff will continue throughout the activity.

Effective leadership in quality and safety in health care means having access to the most recent information

and practical experience. The sharing of best practices is necessary to learn from each other's experiences

and promote quality improvement. The national coordinators of HIVQUAL under the Case Management Unit

of the MoHSS will thus participate in quality improvement conferences to learn from others and share

experiences.

Additional staff for the activity will be required under the Case Management Unit of the DSP, MoHSS as the

program expands both in the number of participating sites and focus areas to include pediatric and PMTCT

indicators. A position for a HIVQUAL Nurse Co-coordinator will be defined and filled to support the

HIVQUAL Medical Officer already working on the project. A part time data manager position will be defined

and filled to provide dedicated support to HIVQUAL so that other data managers will not be pulled away

from their work to support this activity.

This continuing activity, HIVQUAL, relates to Ministry of Health and Social Services (MOHSS) ARV

Services (7330), Potentia ARV Services (7339), I-TECH (7350), HRSA (7450), CTS Global's Strategic

Information activity (7323), US Department of Health and Human Services (HHS)/CDC and Intrahealth

(7406).Funding of this activity will be directed for US based HIVQUAL Consultants to continue their work

with the Namibia in-country HIVQUAL team.

It will expand on the HIVQUAL work which began in Namibia in FY 2007 to reach 16 ART sites. In FY 2008

the program will add 18 new sites throughout all 13 regions to reach all the 34 public and faith-based district

hospitals. In addition, at least 5 health centers will be targeted during 2008. Initially these will be identified

because of their proximity to participating hospitals.

HIVQUAL aims to provide a framework for health services staff and individual health care providers to

engage in a participatory process of quality improvement (QI) based on evidence and data collected they

collect locally. Using the HIVQUAL model, Health Units, Districts, Regions and the MOHSS will be able to

gauge the quality of services provided to the HIV+ population at increasingly higher levels using indicators

based on national guidelines. Data can for the foundation of proposed feasible and sustainable strategies to

improve quality.

In FY 2008, the activity will be conducted under the leadership of the MoHSS Directorate of Special

Programs (DSP) in close collaboration with CDC-Namibia and the US-based HIVQUAL team for technical

support. Activities will include: 1) QI training; 2) assessment of quality management programs at the

participating clinics; 3) performance measurement (at six-month intervals) of selected core indicators; 4)

ongoing QI coaching at participating sites; 5) promotion of consumer engagement in HIV care 6) regular

conference calls with the US-based team. Data analysis and planning for expansion will also occur.

Activities will result in strengthening systems of care and documenting strategic information in health care

facilities. An important emphasis of this approach is to develop providers' skills for collecting and using use

of performance data within their own organizations to improve their systems of care. Use of facility-level

data derived from the national health information system for the purpose of improving quality is an important

goal of HIVQUAL. Training will also be provided to key MOHSS staff at the national, regional, and site level

as indicated.

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

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

assessment, PCP prophylaxis, weight monitoring, food security and alcohol screening. In FY08, HIVQUAL

indicators will also be devised and extended to include PMTCT and Pediatric ART programs. .

HIVQUAL is uniquely facility and region-specific. At the clinic level, QI methods can be adapted 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 it both measures the growth of quality management

activities as well as guides 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 MOHSS.

Regionally, networks of providers who are engaging in quality improvement activities can 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 concept of quality improvement using the HIVQUAL model is still relatively new in Namibia.

Consequently, a lot of advocacy and training will need to be done in order to increase awareness and buy-in

of the initiative by health care providers. Advocacy material for quality improvement will be printed and

disseminated to health care facilities. The bulk of these activities will be undertaken within COP 07 and

continued in COP 08.

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

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

new participants. The training activities will be done in collaboration with I-TECH. Mentoring of Namibia-

based staff will continue throughout the activity.

Effective leadership in quality and safety in health care means having access to the most recent information

and practical experience. The sharing of best practices is necessary to learn from each other's experiences

and promote quality improvement. The national coordinators of HIVQUAL under the Case Management Unit

of the MOHSS will thus participate in quality improvement conferences to learn from others and share

experiences.

Additional staff for the activity will be required under the Case Management Unit of the DSP, MOHSS as the

program expands both in the number of participating sites and focus areas to include pediatric and PMTCT

indicators. A position for a HIVQUAL Nurse Co-coordinator will be defined and filled to support the

HIVQUAL Medical Officer already working on the project. A part time data manager position will be defined

and filled to provide dedicated support to HIVQUAL so that other data managers will not be pulled away

from their work to support this activity.

Activity Narrative: