The ASSIST project will build upon and consolidate achievements made under the Health Care Improvement (HCI) project that ended in December 2012. The program objectives include: building capacity of USG partners to improve the quality of HIV/AIDS, TB/HIV, nutrition, and OVC services; building capacity of Ministry of Health (MoH) and Ministry of Gender, Labor and Social Development (MGLSD) to coordinate and oversee implementation of national quality improvement plans and strategies; and to generate new knowledge and best practices in quality improvement as part of a continuous learning and adapting agenda.

ASSIST project will be expected to: (1) support and strengthen MoH and its Quality Assurance Department to coordinate and oversee the implementation of the national health sector quality improvement framework and strategy; (2) in collaboration with USAID-funded project, Strengthening the Uganda National Response for Implementation of Services for Orphan and Other Vulnerable Children (SUNRISE), ASSIST will support MGLSD, its district structures, and other OVC partners to roll out and institutionalize the national OVC quality assessment, improvement and assurance tools; (3) provide technical assistance and capacity building to all USG implementing partners, including private sector partners, to scale-up quality improvement interventions in supported districts and expand QI approaches to at least, but not limited to, four program areas: VMMC, TB/HIV, PMTCT and OVC; and (4) test a range of quality improvement interventions in selected sites to generate new knowledge and evidence-based best practices to be disseminated to all partners as part of a collaboration, learning and adapting agenda.

This activity is planned through a field support mechanism.

ASSIST will support district health offices and USG implementing partners to scale-up QI approaches in supported districts. This project will support Ministry of Health to coordinate and oversee the interventions. The project will support the continuous quality improvement approach in line with the national health sector quality improvement framework and strategy. This approach applies modern evidence- based quality improvement (QI) methods to reduce the gaps in health care quality and improve outcomes by improving processes of care within the health systems, ultimately contributing to health system strengthening and cost efficiency. The project builds capacity of health workers at facility level to collect baseline information against which demonstrated changes are measured in line with the national standards or indicators.

ASSIST will provide technical assistance to all USG comprehensive HIV/AIDS service delivery partners including, but not limited to, STAR-SW, STAR-E, STAR-EC, NUHITES, SUSTAIN, IRCU, MJAP, MILDMAY, BAYLOR Comprehensive and IDI. The focus will be on the ART framework: increasing enrolment in care of identified HIV positive adults; early initiation of all eligible pre-ART patients onto treatment; increasing retention in care; and improving health outcomes of HIV positive individuals. QI approaches will also be integrated in community health activities to ensure linkages to facility health services, adherence and retention. QI will be used to promote the continuum of response.

Technical Assistance to USG implementing partners will be carried out through:1) training implementing partners technical teams on quality improvement approaches; 2) providing technical assistance in conducting facility and service delivery site quality self-assessments using available national quality improvement self-assessment tools; 3) joint work planning, training, coaching, and mentoring; 4) jointly developing program level quality improvement plans and site level quality improvement plans for HIV/AIDS care services.

ASSIST project will support district community development offices and USG implementing partners to scale-up QI approaches in supported districts. This project will support the implementation of the national vulnerability index and child status index to ensure that OVC services are based appropriately on needs. OVC service delivery partners will be oriented on the national quality improvement standards for protection, care and support of OVCs, trained and continuously supported on integration of QI approaches in OVC quality assessments, referrals, follow-up and measurement of social status outcomes.

In collaboration with SUNRISE, ASSIST will support the roll-out of MGLSD district structures, implement and monitor the use of the national toolkit for OVC quality assessment, OVC quality assurance tools, vulnerability index and child status index. ASSIST and SUNRISE will continue support to district and sub-county OVC committees on implementation of the support supervision guidelines to monitor and improve quality of services.

ASSIST will provide technical assistance to Ministry of Health and all USAID, DOD, and Walter Reed implementing partners on quality improvement of VMMC services. Following identification of VMMC service quality gaps during an interagency EQA assessment conducted in December 2012, USAID, DOD, and Walter Reed plan to continuously improve and monitor quality of services by applying evidence-based quality improvement approaches to address the gaps identified. A site-driven QI process is believed to be more proactive and curative for quality gaps as it is driven by local managers and stakeholders. Therefore, building in-country capacity to apply continuous quality improvement (CQI) methods provides a necessary and complementary strategy for strengthening and maximizing results produced by EQA activities.

ASSIST will provide technical assistance, which will include the following:

Prioritizing gaps in quality identified from EQA assessments in order to focus CQI on identified critical service delivery issues.

Capacity-building and mentorship of front-line providers/managers in 175 VMMC sites, District Health Management Teams (DHMTs), and 13 USG implementing partners to apply CQI methods to improve VMMC service delivery including standardized pre-procedure, procedure, and post-procedure counseling and follow-up.

Use of simple, robust VMMC indicators (e.g. adverse events rate) that can be efficiently collected from existing records to generate regular local data for decision making, continuous improvement, and tracking quality of VMMC services. ASSIST will support data management, particularly, accuracy and completeness of VMMC data in relation to continuous quality improvement. This activity will complement MEEPPs support that focuses on data validity, reliability, completeness, timeliness, accuracy, and relevance.

Support regular shared learning between multiple sites participating in a QI process to accelerate improvement, scale-up and sustainability of high quality VMMC services.

ASSIST will provide technical assistance to all USG partners implementing PMTCT activities for the integration of QI approaches in the roll-out of PMTCT Option B+. The focus will be on the following: (1) Integrate QI in PMTCT four prongs: prevention of HIV in women; prevention of unintended pregnancy in HIV positive women; prevention of mother-to-child transmission; and linking to care and support for HIV positive women, infants, and their families; (2) Integrate QI approaches in PMTCT Option B+ services to promote adherence and retention on ART; (3) Support partnership for HIV free survival (PHFS) participating districts and facilities in application of quality improvement (QI) methods to accelerate the implementation of the 2010 PMTCT WHO guidelines focusing on infant feeding.

Technical Assistance to USG implementing partners will be carried out through: (1) training implementing partners technical teams on quality improvement approaches; (2) providing technical assistance in conducting facility and service delivery site quality self-assessments using available national quality improvement self-assessment tools; (3) joint work planning, training, coaching, and mentoring; (4) jointly developing program level quality improvement plans and site level quality improvement plans for PMTCT.

ASSIST will support MoH to coordinate and oversee the above-mentioned interventions. The project will support the continuous quality improvement approach in line with the national health sector quality improvement framework and strategy.

ASSIST will support district health offices and USG implementing partners to scale-up QI approaches in supported districts. This project will support Ministry of Health to coordinate and oversee the interventions. The project will support the continuous quality improvement approach in line with the national health sector quality improvement framework and strategy. This approach applies modern evidence- based quality improvement (QI) methods to reduce the gaps in health care quality and improve outcomes by improving processes of care within the health systems, ultimately contributing to health system strengthening and cost efficiency. The project builds capacity of health workers at facility level to collect baseline information against which demonstrated changes are measured in line with the national standards or indicators.

ASSIST will provide technical assistance to all USG comprehensive HIV/AIDS service delivery partners including, but not limited to, STAR-SW, STAR-E, STAR-EC, NUHITES, SUSTAIN, IRCU, MJAP, MILDMAY, BAYLOR Comprehensive and IDI. The focus will be on the ART framework: increasing enrolment in care of identified HIV positive adults; early initiation of all eligible patients on treatment; increasing retention and adherence to treatment, especially for Option B+ positive pregnant women; and improving health outcomes of HIV positive individuals. QI approaches will also be integrated in community health activities to ensure linkages to facility health services, adherence and retention. QI will be used to promote the continuum of response.

Technical Assistance to USG implementing partners will be carried out through:1) training implementing partners technical teams on quality improvement approaches; 2) providing technical assistance in conducting facility and service delivery site quality self-assessments using available national quality improvement self-assessment tools; 3) joint work planning, training, coaching, and mentoring; 4) jointly developing program level quality improvement plans and site level quality improvement plans for ART services.

ASSIST project will support district health offices and USG implementing partners to scale-up QI approaches in supported districts. This project will support Ministry of Health coordinate and oversee the interventions. The project will support the continuous quality improvement approach in line with the national health sector quality improvement framework and strategy. The project builds capacity of health workers at facility level to collect baseline information against which demonstrated changes are measured in line with the national standards or indicators.

ASSIST project will provide technical assistance to all USG comprehensive HIV/AIDS service delivery partners including, but not limited to, STAR-SW, STAR-E, STAR-EC, NUHITES, SUSTAIN, IRCU, MJAP, MILDMAY, BAYLOR Comprehensive and IDI.

Pediatric scale-up is a key focus area of COP2012. QI approaches will be used to ensure early identification and diagnosis of HIV positive infants and children. The approach will also be used to promote effective linkage from early diagnosis to early treatment, adherence and retention.

QI approaches will also be integrated in community health activities to ensure linkages to facility health services, adherence and retention. QI approach will be used to promote the continuum of response.

Technical Assistance to USG implementing partners will be carried out through:1) training implementing partners technical teams on quality improvement approaches; 2) providing technical assistance in conducting facility and service delivery site quality self-assessments using available national quality improvement self-assessment tools; 3) joint work planning, training, coaching, and mentoring; 4) jointly developing program level quality improvement plans and site level quality improvement plans for pediatric ART services.