Leveraging an HIV-specific quality improvement programme to realise system-wide benefits in Haiti

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

Joseph JP, Jerome G, Lambert W, Almazor P, Cupidon CE, Hirschhorn LR. AIDS. 2015 Jul;29 Suppl 2:S165-73. doi: 10.1097/QAD.0000000000000715.

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti. The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities. Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records. We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Abstract access  [1]

Editor’s notes: With the current changing HIV-funding landscape, there is increased interest in leveraging disease-specific programmes using a ‘diagonal approach’ to achieve a broader health systems goal. This paper describes a good example of leveraging an HIV-specific quality improvement framework to realise multiple benefits. The authors describe a quality improvement programme which was implemented across 12 health facilities in Haiti. Although the programme was initially HIV-specific, it was expanded to other disease areas including family planning, TB screening and management of heart failure. The spread to other disease areas was facilitated by the programme’s focus on capacity building, resulting in strengthened leadership and ownership across the sites. This paper is a great example of the potential for a ‘diagonal approach’ to maximise system-wide benefits within the context of a vertical programme.  

Health care delivery [4]
Northern America [5]
Haiti [6]
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