243038 Institutionalization of quality improvement activities in Mozambique: Lessons learned, challenges, and recommendations for scale-up

Wednesday, November 2, 2011

Rebecca Dirks , FHI/Arlington, Arlington, VA
Joaquim Fernando , FHI/Mozambique, Niassa, Mozambique
Helena Josť Dinis , FHI/Mozambique, Niassa, Mozambique
Bruno Bouchet , FHI/Arlington, Arlington
Paultre Pierre Desroziers , FHI/Mozambique, Maputo, Mozambique
Jorge Blanco , FHI/Mozambique, Maputo, Mozambique
In October 2009, a quality improvement (QI) activity focusing on HIV and tuberculosis services was piloted in three health centers of Niassa Province, Mozambique, with support from FHI. Monitoring indicators of service quality demonstrated significant variation in service quality improvement across the pilot sites. FHI carried out a qualitative evaluation to identify the factors affecting the success of QI activities in this low-resource setting. MOH officials, FHI staff, and health care workers (HCWs) were interviewed about the perceived benefits, challenges, lessons learned, and recommendations for scale-up of QI activities. HCWs perceived that QI efforts resulted in both improved service provision and increased patient satisfaction. Nearly every person interviewed identified the human resource shortage and staff rotation as significant challenges to implementing QI activities. Leadership and buy-in by hospital management and ongoing support to HCWs through consistent supervision and coaching in QI were also identified as key to the success and institutionalization of QI activities. Recommendations for the sustainable integration of QI into health services include: 1) introducing a system for routine sharing of knowledge and experience among QI teams in the same district; 2) building the QI capacity of all staff in a facility through peer learning and mentoring; and 3) developing a comprehensive national QI policy. A phased strategy is currently being developed to make QI an integral component of strengthening the Mozambique health system.

Learning Areas:
Program planning
Provision of health care to the public
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Objective: Assess the challenges and considerations for implementing and scaling up a Quality Improvement (QI) approach in resource-constrained settings

Keywords: Quality Improvement, Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Bruno Bouchet, MD, MPH, is a Quality Assurance (QA)/Quality Improvement (QI) expert with more than 20 years of experience. Over the past 12 years, he has focused his work on the development and application of modern strategies to improve the quality of healthcare services and the performance of health systems in resource-constrained environments. He is currently the Technical Advisor for QI & Health Systems Strengthening.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.