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

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.