Namibia Project on Retention of Patients on ART (NAMPROPA)
The Ministry of Health and Social Services (MoHSS) Directorate of Special Programs (DSP) in partnership with HEALTHQUAL International and IHI have launched an improvement collaborative focusing on retention in care and to attain viral load suppression among patients on ART in Khomas, Zambezi, and Ohangwena regions to reach the 90-90-90 goals for Namibia by 31 August 2018.
Collaborative measures include; loss to follow-up, viral load monitoring, viral load suppression, hypertension screening and hypertension treatment in ART patients.
Learning Session 1
The first learning session was held 27 February to 1 March in Ondangwa, northern Namibia, with 106 participants from the 24 Collaborative sites. Participants included physicians, nurses, data clerks, health assistants, pharmacy personnel, community health workers, and clinical and nurse mentors as well as representatives from the Ministry of Health and Social Services (MoHSS), CDC-Namibia, IntraHealth, I-TECH, Project HOPE, Development Aid from People to People (DAPP), Institute for Healthcare Improvement (IHI), and HEALTHQUAL-International (HQI).
The learning session addressed collaborative methodology and QI methods, with expert presentations on these topics, including discussion of processes and dissemination of tools for data collection and tracking of QI activities.
Storyboards were presented by teams from participating sites covering baseline performance data on the collaborative measures and current QI activities.
The learning session included facilitated peer exchange and the sharing of innovative strategies from the participating sites. Discussions were led by the National Quality Management team, Clinical Mentors and IHI improvement advisors, providing teams an opportunity to exchange QI approaches and implementation strategies.
Interventions were integrated into the Collaborative’s driver diagram and disseminated. Based on participant feedback and 2016 national ART guidelines, 38 interventions (change ideas) to improve processes and outcomes related to Collaborative aims were integrated into the driver diagram and disseminated. The driver diagram and evolving change ideas incorporate the strategies recommended in the national guidelines for promoting retention.
Action plans were developed by participants to implement during the first “Action Period”. In the final segment of the learning session, teams developed action plans for execution and evaluation of their first PDSA cycle.
Regional coaching teams were trained in advanced QI methods. On 2-3 March 2017, 15 regional clinical and nurse mentors from Khomas, Ohangwena, and Zambezi regions received training on advanced QI practice and methodology. The two-day training was facilitated by improvement advisors from IHI, and included modules on the principles of systems thinking, improvement science, QI coaching and facilitation, data collection, and IHI’s Extranet, a data management platform that will be used by mentors and MoHSS stakeholders to track Collaborative-wide performance. Specific focus on coaching for improvement identified processes to enhance mentors’ existing activities through integration of QI-specific facilitation skills and content.