HIVQUAL/US Health Resources and Services Administration is a continuing mechanism from COP 09

HIVQUAL/US Health Resources and Services Administration has one comprehensive goal and four objectives across the HTXS, HBHC, PDCS and PDTX technical areas. The main goal is to provide technical assistance to the MOHSS to establish a quality improvement program that allows public health facilities to continuously assess the quality of care they deliver to HIV/AIDS patients. Information from this quality improvement program is used by clinic staff to guide efforts to improve HIV care delivery.

To achieve this goal HIVQUAL has the following objectives:

1. Build capacity for MOHSS program officers and health care providers to become more proficient in using quality improvement tools and methodologies to improve HIV care. 2. Establish a quality of care performance measurement system that monitors to what extent treatment and care provided to patients infected with HIV complies with Namibian National Guidelines for HIV/AIDS care. 3. Establish a system to evaluate the results of efforts to improve the quality of HIV/AIDS treatment and care at all public health facilities. 4. Provide technical assistance (TA) on strategies to develop local, regional, and national consumer involvement processes in HIV/AIDS health care programs.

Links to the Partnership Framework goals and benchmarks over the life of its agreement/award. This activity closely supports the commitments of the USG in the partnership framework which is currently under development.

As part of the USG contribution to the goal of "enhancing the quality of care" within the partnership framework implementation plan (PFIP), the USG commits through year five to provide TA to enhance quality management and quality improvement of HIV service delivery. In COP10, the USG will support the roll out of structured quality improvement program to all public HIV treatment and care facilities.

The Implementing Mechanism's geographic coverage and target population(s). In collaboration with USG agencies in Namibia, HIVQUAL will work within the MOHSS to reach out to all public health facilities including those with faith-based affiliations. The target population for the quality improvement program will be all HIV infected children, adolescents and adults receiving HIV care and treatment within all the public health facilities, as well as the health care workers (HCW) staff providing that care.

Key contributions to health systems strengthening Consistent with the new PEPFAR vision of improving sustainability of national programs, HIVQUAL will support efforts to decentralize program management and build program management capacity at regional, district and other sub-national levels. The HIVQUAL approach emphasizes the development of quality improvement systems and processes involving clinic staff and consumers within the MOHSS and other organizational leadership. These structural features are designed to be sustainable even when staff turnover is high or organizational affiliations support change. Through building capacity at the national and local levels for quality improvement and use of strategic information by providers for program improvement, HIVQUAL will strongly contribute to overall health systems strengthening.

Implementing Mechanism's cross-cutting programs and key issues In terms of cross-cutting attributions funding for HIVQUAL contributes towards the Human Resources for Health (HRH) component of Performance Assessment/Quality Improvement.

The Implementing Mechanism's strategy to become more cost efficient over time HIVQUAL values cost efficiency and from the beginning has been working through the structures of the MOHSS, by providing technical assistance through the targeted use of New York-based consultants and the extensive use of USG Namibia technical staff within the program framework. This strategy is consistent with the new PEPFAR vision to ensure cost efficiencies. The MOHSS coordinates the program with other partners in the public sector through its Case Management Unit, and thus is able to expand coverage of the program with low costs. The use of Case Managers also builds human capacity within the MOHSS system. In 2009, the MOHSS took over management of these positions from a private contract firm. This was a first step toward full absorption into the MOHSS human resource system.

Monitoring and evaluation plans for included activities. The activity itself is primarily focused on the utilization of clinical data for improving quality of care. As such, monitoring and evaluation of clinical services is continual. HIVQUAL is required to submit bi-annual progress reports detailing achievements in terms of PEPFAR indicators and other measures specific to the activities. An independent external evaluation was conducted in 2008.

NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES This is a continuing activity from COP2009. It includes five components: (1) Quality Improvement (QI) training; (2) Assessment of quality management programs at participating clinics; (3) Performance measurement (at six-month intervals) on selected core indicators; (4) Ongoing QI coaching and mentoring at participating sites, and; (5) Promotion of patient engagement in HIV care. Funding for HIVQUAL is split between HTXS, PDTX, HBHC and PDCS because the program focuses on quality improvement of clinical services in all four program areas. In COP10, 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. By the end of COP09, the program will have rolled out to all 34 health districts of Namibia, and at least five health centers offering HIV care through the Integrated Management of Adolescent and Adult Illness (IMAI) strategy. Activities in COP10 will focus on quality program implementation in these sites, and expansion to additional health centers. 1) Quality Improvement (QI) training. The USG HIVQUAL team will continue to build capacity for QI among MOHSS staff and healthcare providers in Namibia. Advanced level short term in-service trainings will be provided to staff who have received training in prior years, as well as basic training for new staff. The training activities will be done in collaboration with I-TECH. Specifically activities for COP10 will include Training of Trainers workshops to promote decentralization of QI trainings throughout Namibia, and to support the expanded national quality program. 2) Assessment of quality management programs at the participating clinics. An assessment tool to

measure the capacity of the quality management program at each facility will be used. It will measure the growth of quality management activities as well as the quality of staff members' skills. The findings from these assessments will guide coaching interventions. Aggregated facility-specific data will provide population-level performance data to indicate priorities for national quality improvement activities and campaigns. Similarly, local performance data will be used to improve services at local facilities. 3) Performance measurement (at six-month intervals) on selected core indicators. HIVQUAL will continue to develop providers' skills for collecting and using performance data within their own organizations to improve their HIV treatment and care. Indicators will track the provision of the basic treatment and care package. Selected indicators will include ART services ART adherence, use of Cotrimoxazole prophylaxis, and TB screening. Facility-level data derived from the national health information system will be used to improving quality. 4) Ongoing QI coaching and mentoring at participating sites. In COP10, the program will focus mainly on transferring knowledge and skills to local technical advisors in the MOHSS with the ultimate goal of building country ownership and strengthening sustainability. The transfer of QI skills will be accomplished through coaching and mentoring for MOHSS staff and health care providers. 5) Promotion of consumer engagement in HIV care. HIVQUAL will provide technical assistance to the MOHSS on strategies to develop local, regional, and national strategies and programs to increase consumer (patient) involvement in HIV/AIDS programs. Increased participation by patients and other "consumers" will improve HIV care and treatment services by enhancing the feed-back loop between patients, providers and the MOHSS. Specifically this activity will include working with the MOHSS to devise a written plan for consumer involvement. The plan will outline structures to ensure active participation of people living with HIV/AIDS in the development and improvement of HIV/AIDS programs. This will also include a needs assessment to determine local, regional, and national priorities. Regional civil society groups will be engaged to identify and solicit diverse community opinions. Sustainability: HIVQUAL values cost efficiency. From the beginning the program has worked within MOHSS structures to provide targeted technical assistance from New York-based consultants and from USG Namibia technical staff. This strategy is consistent with the new PEPFAR vision of enforcing country ownership through responsive technical engagement. The MOHSS coordinates the program with other partners in the public sector through its Case Management Unit, and thus is able to expand coverage of the program with low costs. The use of Case Managers also builds human capacity within the MOHSS system. In 2009, the MOHSS took over management of these positions from a private contract firm. This was a first step toward the full absorption of these into the MOHSS human resource system.

NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES

This is a continuing activity from COP09. It has five components: (1) Quality Improvement (QI) training;

(2) Assessment of quality management programs at the participating clinics; (3) Performance

measurement (at six-month intervals) on selected core indicators; (4) Ongoing QI coaching and

mentoring at participating sites; (5) Promotion of consumer engagement in HIV care.

Funding for HIVQUAL is split between HTXS, PDTX, HBHC and PDCS.

In COP10, the activity will be conducted under the leadership of the MOHSS in close collaboration with

CDC Namibia and the US-based HIVQUAL team for technical support. By the end of FY 2009, the

program will have rolled out to all 34 health districts of Namibia, and at least five health centers offering

HIV care through the Integrated Management of Adolescent and Adult Illness (IMAI) strategy.

1. Quality Improvement (QI) training. The USG HIVQUAL team will continue to build capacity for QI

among MOHSS staff and providers in Namibia and provide advanced level short term in-service trainings

for existing participants, as well as basic training for new participants. The training activities will be done

in collaboration with I-TECH. Activities for COP10 will include a Training of Trainers' workshop to enable

decentralization of QI trainings throughout Namibia and to support the expanded national quality

program.

2. Assessment of quality management programs at the participating clinics. An assessment tool to

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

the growth of quality management activities as well as guide the coaching interventions. Aggregated

facility-specific data can provide population-level performance data that indicate priorities for national

quality improvement activities and campaigns.

3. Performance measurement (at 6-month intervals) on selected core indicators. HIVQUAL will continue

to develop providers' skills for collecting and using performance data to improve their HIV treatment and

care. Indicators will include assessment of the provision of the basic treatment and care package,

including ART provision and ART adherence, Cotrimoxazole prophylaxis and TB screening. Use of

facility-level data derived from the national health information system will continue to be an important goal

of HIVQUAL. HIVQUAL provides a framework for health services staff and individual health care

providers to engage in a participatory process of quality improvement based on evidence and data

collected locally. Using the HIVQUAL model, health units, districts, regions and the MOHSS will be able

to gauge the quality of clinical HIV services based on national guidelines. Activities will strengthen the

provision of quality care and the documentation of key strategic information in health care facilities.

4. Ongoing QI coaching and mentoring at participating sites. In COP10, the program will focus mainly on

transferring knowledge and skills to technical advisors in the MOHSS and CDC Namibia with the ultimate

goal of ensuring sustainability of the program in the long term. The USG HIVQUAL team will continue to

focus on building quality improvement coaching skills among MOHSS staff and provide mentorship to

health care providers.

5. Promotion of consumer engagement in HIV care. HIVQUAL develop strategies to enhance local,

regional, and national consumer involvement in HIV/AIDS health care programs to improve the quality of

HIV health care provided. Specifically, this activity will include working with the MOHSS (in-country and

through US study tours) to devise a written plan for consumer involvement. The plan will outline

structures to ensure active participation of PLWHIVA in the continuous development and improvement of

HIV/AIDS programs. This includes the development of a needs assessment to determine local, regional,

and national priorities. Engagement will be done with regional civil society groups to identify and solicit

diverse community members who are interested in pursuing consumer involvement in HIV quality

improvement activities.

Special focus within the Pediatric Care and Support area will engage adolescents living with HIV through

formation of site specific Young Adults Consumer Advisory Committees (YACACs). Training will be

offered to affirm and support the consumer's role in HIV health care and treatment. Qualitative and

Quantitative evaluation measures will be developed to evaluate the success of the proposed project. This

strategy is aimed at effectively meeting the service needs of pediatric and adolescents living with

HIV/AIDS, while addressing ethical issues that may arise. This strategy is also likely to further support

adherence to treatment and care by PLWHIA.

Sustainability: HIVQUAL values cost efficiency. From the beginning the program has worked with

MOHSS structures to provide targeted technical assistance from New York-based consultants and from

USG Namibia technical staff. This strategy is consistent with the new PEPFAR vision of enforcing country

ownership through responsive technical engagement. The MOHSS coordinates the program with other

partners in the public sector through its Case Management Unit, and thus is able to expand coverage of

the program with low costs.

NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes five main components: (1) Quality Improvement (QI) training; (2) Assessment of quality management programs at participating clinics; (3) Performance measurement (at six-month intervals) on selected core indicators; (4) Ongoing QI coaching and mentoring at participating sites, and; (5) Promotion of patient engagement in HIV care. Funding for HIVQUAL is split between HTXS, PDTX, HBHC and PDCS because the program focuses on quality improvement of clinical services in all four program areas. In COP10, 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. By the end of COP09, the program will have rolled out to all 34 health districts of Namibia, and at least five health centers offering HIV care through the Integrated Management of Adolescent and Adult

Illness (IMAI) strategy. Activities in COP10 will focus on quality program implementation in these sites, and expansion to additional health centers. (1) Quality Improvement (QI) training. The USG HIVQUAL team will continue to build capacity for QI among MOHSS staff and healthcare providers in Namibia. Advanced level short term in-service trainings will be provided to staff who have received training in prior years, as well as basic training for new staff. The training activities will be done in collaboration with I-TECH. Specifically activities for COP10 will include Training of Trainers workshops to promote decentralization of QI trainings throughout Namibia, and to support the expanded national quality program. (2) Assessment of quality management programs at the participating clinics. An assessment tool to measure the capacity of the quality management program at each facility will be used. It will measure the growth of quality management activities as well as the quality of staff members' skills. The findings from these assessments will guide coaching interventions. Aggregated facility-specific data will provide population-level performance data to indicate priorities for national quality improvement activities and campaigns. Similarly, local performance data will be used to improve services at local facilities. (3) Performance measurement (at six-month intervals) on selected core indicators. HIVQUAL will continue to develop providers' skills for collecting and using performance data within their own organizations to improve their pediatric HIV treatment and care. Pediatric indicators will track the provision of the basic pediatric treatment and care package. Selected indicators will include ART services ART adherence, growth monitoring, nutrition assessment, immunizations, use of Cotrimoxazole prophylaxis, and TB screening. Facility-level data derived from the national health information system will be used to improving quality. (4) Ongoing QI coaching and mentoring at participating sites. In COP10, the program will focus mainly on transferring knowledge and skills to local technical advisors in the MOHSS with the ultimate goal of building country ownership and strengthening sustainability. The transfer of QI skills will be accomplished through coaching and mentoring for MOHSS staff and health care providers. (5) Promotion of consumer engagement in HIV care. HIVQUAL will provide technical assistance to the MOHSS on strategies to develop local, regional, and national strategies and programs to increase consumer (patient) involvement in HIV/AIDS programs. Increased participation by patients and other "consumers" will improve HIV care and treatment services by enhancing the feed-back loop between patients, providers and the MOHSS. Special focus within the Pediatric Care and Support area will be paid on engaging adolescents living with HIV through formation of site specific Young Adults Consumer Advisory Committees (YACACs). Specifically this activity will include working with the MOHSS to devise a written plan for consumer involvement. The plan will outline structures to ensure active participation of people living with HIV/AIDS in the development and improvement of HIV/AIDS programs. This will also include a needs assessment to determine local, regional, and national priorities. Regional civil society groups will be engaged to identify and solicit diverse community opinions. Sustainability: HIVQUAL values cost efficiency. From the beginning the program has worked MOHSS

structures to provide targeted technical assistance from New York-based consultants and from USG Namibia technical staff. This strategy is consistent with the new PEPFAR vision of enforcing country ownership through responsive technical engagement. The MOHSS coordinates the program with other partners in the public sector through its Case Management Unit, and thus is able to expand coverage of the program with low costs. The use of Case Managers also builds human capacity within the MOHSS system. In 2009, the MOHSS took over management of these positions from a private contract firm. This was a first step toward the full absorption of these into the MOHSS human resource system.

NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes five components: (1). Quality Improvement (QI) training; (2) Assessment of quality management programs at participating clinics; (3) Performance measurement (at six-month intervals) on selected core indicators; (4) Ongoing QI coaching and mentoring at participating sites, and; (5) Promotion of patient engagement in HIV care. Funding for HIVQUAL is split between HTXS, PDTX, HBHC and PDCS because the program focuses on quality improvement of clinical services in all four program areas. In COP10, 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. By the end of COP09, the program will have rolled out to all 34 health districts of Namibia, and at least five health centers offering HIV care through the Integrated Management of Adolescent and Adult Illness (IMAI) strategy. Activities in COP10 will focus on quality program implementation in these sites, and expansion to additional health centers. 1) Quality Improvement (QI) training. The USG HIVQUAL team will continue to build capacity for QI among MOHSS staff and healthcare providers in Namibia. Advanced level short term in-service trainings will be provided to staff who have received training in prior years, as well as basic training for new staff. The training activities will be done in collaboration with I-TECH. Specifically activities for COP10 will include Training of Trainers workshops to promote decentralization of QI trainings throughout Namibia, and to support the expanded national quality program. 2) Assessment of quality management programs at the participating clinics. An assessment tool to measure the capacity of the quality management program at each facility will be used. It will measure the growth of quality management activities as well as the quality of staff members' skills. The findings from these assessments will guide coaching interventions. Aggregated facility-specific data will provide population-level performance data to indicate priorities for national quality improvement activities and campaigns. Similarly, local performance data will be used to improve services at local facilities.

3) Performance measurement (at six-month intervals) on selected core indicators. HIVQUAL will continue to develop providers' skills for collecting and using performance data within their own organizations to improve their pediatric HIV treatment and care. Pediatric indicators will track the provision of the basic pediatric treatment and care package. Selected indicators will include ART services ART adherence, growth monitoring, nutrition assessment, immunizations, use of Cotrimoxazole prophylaxis, and TB screening. Facility-level data derived from the national health information system will be used to improving quality. 4) Ongoing QI coaching and mentoring at participating sites. In COP10, the program will focus mainly on transferring knowledge and skills to local technical advisors in the MOHSS with the ultimate goal of building country ownership and strengthening sustainability. The transfer of QI skills will be accomplished through coaching and mentoring for MOHSS staff and health care providers. 5) Promotion of consumer engagement in HIV care. HIVQUAL will provide technical assistance to the MOHSS on strategies to develop local, regional, and national strategies and programs to increase consumer (patient) involvement in HIV/AIDS programs. Increased participation by patients and other "consumers" will improve HIV care and treatment services by enhancing the feed-back loop between patients, providers and the MOHSS. Special focus within the Pediatric Care and Support area will be paid on engaging adolescents living with HIV through formation of site specific Young Adults Consumer Advisory Committees (YACACs). Specifically this activity will include working with the MOHSS to devise a written plan for consumer involvement. The plan will outline structures to ensure active participation of people living with HIV/AIDS in the development and improvement of HIV/AIDS programs. This will also include a needs assessment to determine local, regional, and national priorities. Regional civil society groups will be engaged to identify and solicit diverse community opinions. Sustainability: HIVQUAL values cost efficiency and to this end has worked within MOHSS structures to provide targeted technical assistance from New York-based consultants and from USG Namibia technical staff. This strategy is consistent with the new PEPFAR vision of enforcing country ownership through responsive technical engagement. The MOHSS coordinates the program with other partners in the public sector through its Case Management Unit, and thus is able to expand coverage of the program with low costs. The use of Case Managers also builds human capacity within the MOHSS system. In 2009, the MOHSS took over management of these positions from a private contract firm. This was a first step toward the full absorption of these into the MOHSS human resource system.