ACTIVITY DESCRIPTION:

In COP08, USG PEPFAR-Nigeria will, in collaboration with the Federal Ministry of Health, the New York

State Department of Health - AIDS Institute (NYSDOH-AI) and other partners, identify and train HIV/AIDS

care providers in the implementation of the N-HIVQUAL project across the country. A total of 40 new sites

will be activated and 129 personnel will be trained in COP 08 on the three key components of HIVQUAL

namely: performance assessment, quality improvement and infrastructural improvement. This activity will

build upon the progress made in establishing N-HIVQUAL from COP06 through COP07. An additional of

HIVQUAL in COP08 will be the training of three additional persons per site from the Consumer Group

comprising People Living with HIVAIDS (PLWHAs) and People affected by HIV/AIDS (PABAs).

The implementation of the PEPFAR project in Nigeria has from inception in 2004 focused mainly on

achieving set targets through expansion from tertiary health facilities down to the primary healthcare centers

(PHC) for expanded access of services. Over these periods, standards, national guidelines and standard

operating procedures (SOPs) were developed to guide the delivery of the highest quality of HIV/AIDS

services within the national context.

In FY 06, USG, GON and other implementing partners (IPs) identified the need to emphasize adherence to

the various guidelines and standards across service providers as well as institutionalize the culture of

continuing quality improvement of Services. This led to the adoption of the HIVQUAL model of quality

assessment of antiretroviral therapy (ART) care, to identify gaps and subsequently improve the quality of

services being provided through infrastructural improvement, performance measurement and continuing

quality improvement (CQI) activities.

The COP08 activity will build upon the N-HIVQUAL work for which advocacy began in FY 2006 to establish

N-HIVQUAL programs and to commence HIVQUAL Implementation in 20 pilot sites by the end of FY07.

These sites are scheduled for assessment, and subsequent training of 60 key personnel from the various

selected sites will follow rapidly. Equipments and materials to facilitate data management will be supplied to

these pilot sites and to the HIV/AIDS division of the Federal Ministry of Health (FMoH). Data collection of

first set of performance indicators across the 20 sites will be achieved in the third quarter, while collation

and analysis using the first version of the N-HIVQUAL software will be completed in the last quarter of

FY07.

In COP08, the program will be expanded to an additional 40 new sites, to achieve at least one site per state

in all the thirty six states and the FCT-Abuja. These sites will generate two national and four zonal review

reports in the program year. Furthermore, a total of another 60 people to include facility managers,

clinicians, and M&E staff will be trained in COP08 to give a cumulative total of 189 facility staff trained on

HIVQUAL. In COP08 a new addition onto the quality improvement process will be the identification and

training of three members of support groups consisting PLWHAs and PABAs so as to empower them to

play active roles in the process. Thus a total of 180 persons will be trained (60 from COP07 sites and 120

from the new COP08 sites).

N-HIVQUAL software will also be upgraded to include indicators from other program lines. This will provide

a clue of the overall performance of the HIV/AIDS services in those facilities. The goal of HIVQUAL is to

allow health services and individual health care providers to engage in a participatory process of QI based

on evidence and data collected locally by their own teams. Using the HIVQUAL model, health facilities at

various levels of care, States Ministry of Health (SMoH) and the Federal Ministry of Health (FMOH) as well,

will be able to gauge the quality of services provided using indicators based on national guidelines. Feasible

and sustainable strategies to improve quality through implementation of these established standards of

HIV/AIDS service delivery is also part of the HIVQUAL process.

Established indicators to be measured through N-HIVQUAL will determine the level of continuity of care,

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

assessment, weight monitoring, cotrimoxazole preventive therapy (CPT), and food security. The specific

emphasis of this activity is at the clinic-level and will adapt 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.

Facility-specific data will be aggregated to provide state, and national level performance data that indicate

priorities for national quality improvement activities and campaigns.

The proposed approach of N-HIVQUAL is to establish zonal networks of providers that will engage in QI to

enable teamwork that will address problems unique to each area, including, for example, human resource

shortages and coordination of care among multiple agencies as well as adherence to care services. A

national training of trainers (TOT) on Total Quality Management (TQM) will be conducted for treatment

implementing partners, FMOH staff and major national stakeholders with technical assistance from the New

York State Department of Health and Human Services (NYDHHS). Involvement and partnership with all

treatment partners will help disseminate quality improvement strategies and activities throughout their

networks.

The USG HIVQUAL team in collaboration with the IPs will expand its focus to build quality improvement

coaching skills among GON staff and providers in Nigeria, to provide advanced level training for sites to

ensure buy-in and address specific peculiarities. Also included will be a basic training for new participants.

Mentoring on QI processes and strategies for staff will continue throughout the activity. One of the goals for

COP will be to develop the capacity of the identified lead staff within the USG or MoH to provide direction

for the project.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The proposed activity will result in the capacity development of service providers at all tiers of health

delivery in the area of Quality Improvement. This will further ensure qualitative growth and sustainability in

the Care and treatment services provided with USG funds.

LINKS TO OTHER ACTIVITIES:

This activity is directly linked to the HIVQUAL program of the NYSDOH which will provide technical

assistance and direct mentoring to the N-HIVQUAL project. The NSDOH-AI will utilize their pipeline -funds

from COP06 and COP07 to support travel to and from the USA and within Nigeria during the initial intensive

Activity Narrative: mentoring phase. It will also support the development and modification of HIVQUAL Software and the in-

country training of Nigerian personnel on the use of the software. This activity will also be linked to other

treatment and care program areas. N-HIVQUAL will collaborate with USG IPs, GON, and other

stakeholders at all levels to improve quality of services, build capacity on data collection, reporting and use,

and form linkages as appropriate, especially with other SI capacity building activities.

POPULATIONS BEING TARGETED:

The populations being targeted in COP08 include care and treatment service providers in 40 additional sites

as well as support the National AIDS/STDs Control Program in Coordinating the National HIVQUAL Project.

At least three facility level staff in each site; six zonal core trainers as well as three NASCP Staff will be

trained. Additional three persons per site from the Consumer Group comprising People Living with HIVAIDS

(PLWHAs) and People affected by HIV/AIDS (PABAs) will also be trained on their roles and active

participation in Service Quality Improvement. A total of 129 hospital personnel and 180 consumers will be

trained in COP08.

EMPHASIS AREAS:

An emphasis will be placed on human capacity development.