AN ASSESSMENT OF THE APPLICATION OF QUALITY IMPROVEMENT CONCEPTS BY HEALTH CARE WORKERS TRAINED UNDER THE AIDSFREE PROJECT IN ZIMBABWE
The goal of the HIV quality improvement (QI) program in Zimbabwe is to provide care that meets or exceeds clients' expectations and aligns with national HIV prevention, care, and treatment guidelines. Implementation of the HIV QI program is guided by the National Quality Assurance/Quality Improvement (QA/QI) Policy and the National Quality Improvement Strategy. Between 2015 and 2016, the U.S. Agency for International Development- and U.S. President’s Emergency Plan for AIDS Relief-funded Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project supported Zimbabwe Ministry of Health and Child Care (MOHCC) with technical assistance to build the capacity of facilities and health care providers in QI programming. Through this assistance, a total of 59 health care workers (HCWs) from 38 health facilities received formal training in HIV QI, followed by systematic post-training coaching and mentoring. In November 2016, AIDSFree conducted a post-training assessment to determine the extent to which trained HCWs applied the knowledge and skills they had gained three months after the training. The team also assessed the extent to which providers' respective facilities implemented quality management/quality improvement (QM/QI) activities and changes in QM/QI indicators before and after training.
AIDSFree conducted a cross-sectional study covering all the HCWs trained between May and July 2016 and the facilities from which they came. The assessment used the standard organizational assessment (OA) tool used in the national program and semi-structured interviews to collect data on the extent of QM/QI implementation and application of knowledge and skills, respectively. The team conducted retrospective health facility record review to determine changes in QM/QI indicators before and after training; and conducted focus group discussions (FGDs) to explore barriers and enablers and provide program context.
There was a good retention and response rate (93%) among the trained HCWs. Most (96.3%) of the trained HCWs were intensely involved in facility-level QM/QI programming. Almost two-thirds (64.6%) found the training very useful and 78 percent were able to correctly match the QI tool with the corresponding processes of QI implementation.
The extent of QM/QI implementation ranged from a mean domain score of 0.97 to 1.94 of a possible five across the nine QM/QI domains. This was a significant improvement from mean domain scores ranging from 0.14 to 1.04 before the training (p<0.05). Eight of fourteen QI indicators tracked in the national QI program significantly improved after the training, but six did not change.
These differences were amplified after stratifying by the availability of post-training support to the facility. Availability of support from the leadership and QI coaches, time, and teamwork were enablers for application of QM/QI knowledge and skills; lack of staff and equipment were notable barriers. Most of the respondents had adaptive strategies to mitigate these barriers.
Facility-level HCWs should receive post-training support after formal QI training to sustainably improve the application of learned skills and knowledge, and thus QM/QI implementation.