COPE for ART – Improving patient quality at low cost

Background: Around Africa, anti-retroviral therapy is being scaled-up and millions more people have access. Assuring the quality of these new services is a major challenge given serious human resource and financial constraints.

Design: The Quality Health Partners project (funded by USAID, managed by EngenderHealth) and the Ghana National Aids Control Program worked with health facility staff in 10 sites from September 2006 to June 2007 to introduce a quality assurance process for ART and HIV clinical care. A package of quality assurance tools and interventions (COPE©) was adapted for ART to introduce a participatory process where facility staff undertake a structured self-assessment of HIV-related services, identify problems and develop action plans to address problems. Action plans are reviewed and when most problems have been solved the self-assessment process is repeated to identify and address new issues affecting service provision.

Results: Nine of the ten facilities were followed up within six months of initiating a COPE for ART Action Plan. On average, facilities had addressed 52.1% of the problems they identified, ranging from a low of 33.3% to a high of 75.7% of problems addressed, using resources within their control. Target facilities have achieved increased problem solving capacity and coordination of services at almost no cost.

Conclusions: Quality assurance activities need to be built into policy and resourced from the outset, especially when scaling up an ART program nationally. These activities do not need to be cost prohibitive, but can utilize local solutions at the facility level.