1. Overall goals and objectives Goal: Improve the care and treatment of individuals with HIV/AIDS by building capacity and capabilities for quality management activities at the national, regional, district and facility level

Objectives 1: Provide Technical Assistance in the development of a national quality management program. The development of a national framework for quality will help systematize activities across the entire health system infrastructure. The program will provide technical assistance in the development of a national quality management plan and a strategic plan which will guide the activities and the integration of quality improvement into the existing national health system infrastructure. To accomplish this, the program will continue to work closely with senior MOH leadership to assure the quality program reflects the vision of the MOH. Strategies for implementation will be developed and implemented, with communication of plans to all levels of the health system. A Quality Steering Committee, begun in 2008 will continue to provide oversight of these activities and will help to provide harmonization of multiple QI programs currently supporting the country. This group meets monthly and technical assistance will be provided as needed. A key stakeholders meeting to guide the process and provide regular input and analysis will meet at least annually to review and update performance measures and help establish improvement priorities. An annual national assessment will be performed to assess the nation's progress in developing a sustainable quality management infrastructure. A technical assistance plan will be targeted to specific components needing improvement. System indicators will be implemented.

Objective 2: Promote sustainable quality improvement activities in 127 community and hospital based clinics across all regions in the country. A total of 127 clinics will receive coaching and mentoring from core team and district health supervisors through regular visits. Trained district coaches will receive ongoing training and technical assistance and peer learning opportunities provided. During biannual regional learning networks participating clinics will report on their QI activities to promote peer learning and to identify successful strategies. Assistance will be provided for sites to develop story boards demonstrating successful QI projects. Benchmarking data reports will be provided to allow sites to compare themselves to others in their region.

HIVQUAL will continue to collaborate with implementing partners to identify technical assistance needed to support QI activities in facilities they support. Regular meetings will be held with implementing partner leadership to identify technical assistance needs. Implementing partners will be included in key stakeholders meeting to provide input on indicators and in regional learning networks to share best practices. This will help to leverage resources across programs and to reduce redundancy in QI efforts. Partners will are also invited to attend monthly Quality Steering Committee.

Objective 3: Develop and implement performance measurements to assess the quality of care provided at approximately 127 community- and hospital-based clinics. Indicators will continue to be utilized during biannual data collection periods. Indicators will include adult, pediatric, and, PMTCT in FY 2011. Key stakeholders will provide feedback on an annual basis to assure indicators are aligned with national priorities and national treatment guidelines.

Bi-annual national reports will be compiled and generated. Reports will be stratified by region and by district. Reports will be reviewed by the Quality Steering Committee and the key stakeholders group to help set national priorities and benchmarking reports will provided to attendees of regional groups.

2. Target population and geographic coverage HIVQUAL targets healthcare staff at 127 community and hospital-based clinics throughout Uganda. All regions within the country have some HIVQUAL participating clinics. Additional targeted clinics will include those facilities with no current support for QI activities from HIVQUAL or other implementing partners, in particular HCI.

3. Enhancing cost effectiveness and sustainability Cost savings will continue to be accomplished through the training and deployment of MOH officials at the district level. These individuals will provide local coaching and mentoring, whereby the central team will be able to reduce significant travel costs.

Collaboration with other implementing partners to assure that national coverage is met without duplication of partner activities. HIVQUAL and HCI have already assured that only program is functioning in each site.

4. Health system strengthening HIVQUAL continues to support the development of a national quality plan and a strategic plan to help integrate QI into the national health system structure and assess Ministry restructuring that occurred in 2010

5. Cross-cutting budget attributions As HIVQUAL is a quality improvement capacity building program for MOH and clinic based staff at the national, regional, and local level in Uganda, as well as aiding in the development of a national quality management plan for HIV care, cross-cutting budget attributions are indirect through healthcare and MOH staff development in the area of quality improvement and improving care and treatment provided to HIV- infected patients.

6. Key issues: Depending upon the quality improvement activities chosen by the participating clinics during the COP 11 timeframe, any of the key issues may be addressed through the program. End of program monitoring includes the analysis of clinical indicator performance measure results, national and organizational assessments and the number of health care workers trained will be used to monitor and evaluate the program.

1. Target populations and coverage of target population or geographic area HIVQUAL targets healthcare staff at all HIV service outlets particularly for those without partner support (community and hospital-based clinics) throughout the country. All regions within the country have some HIVQUAL participating clinics. Additional targeted clinics will include those facilities with no current support for QI activities from HIVQUAL or other implementing partners.

2. Description of service delivery or other activity carried out A total of 127 clinics will receive coaching and mentoring from core team and district health supervisors through regular onsite visits, telephone calls and email (when available). District coaches will receive ongoing training, technical assistance and peer learning opportunities. During biannual regional learning networks participating clinics will report on their QI activities to promote peer learning and to identify successful strategies. Assistance will be provided for sites to develop story boards demonstrating successful QI projects. Benchmarking data reports will be provided to allow sites to compare themselves to others in their region.

Collaborate with implementing partners to identify technical assistance needed to support QI activities in facilities they support. Regular meetings will be held with implementing partner leadership to identify technical assistance needs. Implementing partners will be included in key stakeholders meeting to provide input on indicators and in regional learning networks to share successful strategies. This will help to leverage resources across programs and to reduce redundancy in QI efforts.

Indicators will continue to be utilized during biannual data collection periods. Key stakeholders will provide feedback on an annual basis to assure indicators are aligned with national priorities and national treatment guidelines.

Bi-annual national reports will be prepared and reviewed at the national, regional, district and facility

level. Reports will be stratified by region and district. Reports will be reviewed by the Quality Steering Committee and the key stakeholders group to help set national priorities.

3. Integration with other health activities Cost savings will continue to be accomplished through the training and deployment of MOH officials at the district level. These individuals will provide local coaching and mentoring, whereby the central team will be able to significantly reduce travel costs.

HIVQUAL will continue to collaboration with other implementing partners to assure that national coverage is met without duplication of partner activities. HIVQUAL and HCI have already assured that only one program is functioning in each site.

As HIVQUAL is a quality improvement capacity building program for MOH and clinic based staff at the national, regional, and local level in Uganda, as well as aiding in the development of a national quality management plan for HIV care, cross-cutting budget attributions are indirect through healthcare and MOH staff development in the area of quality improvement and improving care and treatment provided to HIV-infected patients.

4. Relation to the national program The development of a national framework for quality will help systematize activities across the entire health system infrastructure. The program will continue to provide technical assistance in the development of a national quality management plan and a strategic plan to guide the activities and the integration of quality improvement into the existing national health system infrastructure. To accomplish this, the program will continue to work closely with senior MOH leadership to assure the quality program reflects the MOH vision and organizational structure. Strategies for implementation will be harmonized with other QI activities and reflected in a workplan. A Quality Steering Committee, begun in 2008 will continue to provide oversight of these activities. This group meets quarterly. A core team, comprised of technical officers from ACP, clinical services, and quality assurance department, meets monthly. Technical assistance will be provided as needed. A key stakeholders meeting to guide the process and provide regular input and analysis will meet at least annually to review and update performance measures and help establish improvement priorities. An annual national assessment will be performed to assess the nation's progress in developing a sustainable quality management infrastructure. A technical assistance plan will be targeted to specific components needing improvement. System indicators will be finalized and implemented.

5. Health Systems Strengthening and Human Resources for Health HIVQUAL continues to support the development of a national quality plan and a strategic plan to help

integrate QI into the national health system structure and assess Ministry restructuring that occurred in 2010. Capturing of QI interventions and strategies for improvement will be prioritized during FY 2011 with analysis and dissemination of successful strategies regularly conducted. Systems issues and barriers of improvement will be addressed at the national level and discussed at the Steering committee. Program monitoring includes the analysis of clinical indicator performance measure results, national and organizational assessments, and the number of health care workers trained and clinics initiated in QI. The program will target harmonizing QI training package for health workers and health managers and harmonizing of measures based on national indicators the will allow for national bench marking.

a. Target population and geographic coverage HIVQUAL targets healthcare staff implementing QI activities at all community and hospital-based clinics throughout the country. Pediatric facilities in all regions of the country will be addressed in 2011. Additional targeted clinics will include those facilities with no current support for QI activities from HIVQUAL or other implementing partners.

b. Service delivery A total of 127 clinics will receive coaching and mentoring from core team and district health supervisors through regular onsite visits, telephone calls and email (when available). District coaches will receive ongoing training, technical assistance and peer learning opportunities. Implementing partners focused on pediatrics (Baylor Uganda, Mildmay Uganda) will continue to be engaged and supported in the development of organizational QM programs. During biannual regional learning networks participating clinics will report on their QI activities to promote peer learning and to identify successful strategies. Assistance will be provided for sites to develop story boards demonstrating successful QI projects. Benchmarking data reports will be provided to allow sites to compare themselves to others in their region.

HIVQUAL will continue to collaborate with implementing partners to identify technical assistance needed to support QI activities in facilities they support. Regular meetings will be held with implementing partner leadership to identify technical assistance needs. Implementing partners will be included in key stakeholders meeting to provide input on indicators and in regional learning networks to share successful strategies. This will help to leverage resources across programs and to reduce redundancy in QI efforts.

Indicators will continue to be utilized during biannual data collection periods. Key stakeholders will provide feedback on an annual basis to assure indicators are aligned with national priorities and national

treatment guidelines.

Bi-annual national reports will be prepared and reviewed at the national, regional, district and facility level. Reports will be stratified by region and district. Reports will be reviewed by the Quality Steering Committee and the key stakeholders group to help set national priorities.

c. Integration with other health activities Cost savings will continue to be accomplished through the training and deployment of MOH officials at the region and district level and individuals in local NGO's focusing on pediatrics. These individuals will provide local coaching and mentoring, whereby the central team will be able to significantly reduce travel costs.

Collaboration with other implementing partners to assure that national coverage is met without duplication of partner activities. HIVQUAL and HCI have already assured that only one program is functioning in each site.

As HIVQUAL is a quality improvement capacity building program for MOH and clinic based staff at the national, regional, and local level in Uganda, as well as aiding in the development of a national quality management plan for HIV care, cross-cutting budget attributions are indirect through healthcare and MOH staff development in the area of quality improvement and improving care and treatment provided to HIV-infected children.

d. Relation to the national program The development of a national framework for quality will help systematize activities across the entire health system infrastructure. The program will continue to provide technical assistance in the development of a national quality management plan and a strategic plan to guide the activities and the integration of quality improvement into the existing national health system infrastructure. To accomplish this, the program will continue to work closely with senior MOH leadership to assure the quality program reflects the MOH vision and organizational structure. Strategies for implementation will be harmonized with other QI activities and reflected in a workplan. A Quality Steering Committee, begun in 2008 will continue to provide oversight of these activities. This group meets quarterly. A core team, comprised of technical officers from ACP, clinical services, and quality assurance department, meets monthly, Technical assistance will be provided as needed. A key stakeholders meeting to guide the process and provide regular input and analysis will meet at least annually to review and update performance measures and help establish improvement priorities. An annual national assessment will be performed to assess the nation's progress in developing a sustainable quality management infrastructure. A technical assistance plan will be targeted to specific components needing improvement. System indicators will be

finalized and implemented.

e. Health systems strengthening and human resources for health HIVQUAL continues to support the development of a national quality plan and a strategic plan to help integrate QI into the national health system structure and assess Ministry restructuring that occurred in 2010. Pediatric HIV/AIDS is included in this plan and QI interventions and strategies for improvement prioritized during FY 2011 with analysis and dissemination of successful strategies regularly conducted. Systems issues and barriers of improvement will be addressed at the national level and discussed at the Steering committee. Program monitoring includes the analysis of clinical indicator performance measure results, national and organizational assessments, and the number of health care workers trained and clinics initiated into QI.