QAP has been working in Niger since the founding of the Tahoua Quality Assurance Project in 1993. The Niger QAP program includes a Pediatric Hospital Improvement (PHI) collaborative and an Essential Obstetric and Newborn (EONC) collaborative, operating respectively in 73% and 62% of Niger’s first referral health centers. The PHI and EONC collaboratives reinforce a maternal-newborn-child health continuum in shared sites in a country with some of the highest maternal (700/100,000), newborn (44/1000), and early childhood (276/1000) mortality rates in the world.
- Pediatric Hospital Improvement (PHI) collaborative to improve first referral care of seriously ill and malnourished children in 32 hospitals, with a focus on improving care of malaria, pneumonia, diarrheal disease, malnutrition, and Emergency Triage Assessment and Treatment (ETAT) services.
- Rapid Expansion of services for malnourished children as part of PHI collaborative: 2006 Office of U.S. Foreign Disaster Assistance (OFDA) grant supports expansion of PHI services for malnourished children in aftermath of 2005 Nigerien food crisis, in close collaboration with UNICEF and HKI (see URC-CHS website)
- Essential Obstetric Newborn Care collaborative to improve first referral prenatal, delivery, and post-partum care for women and newborns in 28 maternity hospitals, with a focus on improved Antenatal Care (ANC), Essential Newborn Care (ENC), effective Partogram use, Active Management of Third Stage of Labor (AMTSL), Infection Prevention, and management of obstetric and newborn complications.
- Operations Research to evaluate impact of PHI collaborative for improving quality of malaria and pneumonia care in 6 Nigerien district hospitals (intervention and control sites). Final data collection and analysis pending late 2006/early 2007.
- PHI: 32 sites: 22/33 district hospitals; 7/8 regional hospitals, 3/3 national hospitals (OFDA/UNICEF-funded malnutrition program active in 21/32 PHI sites)
- EONC: 28 maternity hospitals: 21/33 district hospitals, 4/8 regional hospitals, 3/3 national hospitals.
- National MOH program, Integrated Management of Newborn and Childhood Illness (IMNCI).
- MOH, Direction de la Sante de la Reproduction (DSR)
- Country WHO, UNICEF, HKI, and UNFPA programs
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QAP has provided support to the Ministry of Health's Division for the Promotion of Quality Health Services since 1998. Currently, QAP is participating in the development of quality improvement collaboratives regarding treatment procedures and services for HIV/AIDS, Malaria, and Essential Obstetric Care.
- Implement a national (Prevention of Mother-to-Child-Transmission of HIV) PMTCT/Plus improvement collaborative in 15 sites involving ten partners
- Implement a malaria case management improvement collaborative involving four districts
- Implement an Essential Obstetric Care Improvement Collaborative in two districts
- Provide technical assistance to the Central Hospital of Kigali to improve care of the Internal Medicine Department
- Provide technical assistance and training to the DPQS to develop the QA capacity of the MOH
- Ministry of Health
- Central Hospital of Kigali
- Division for the Promotion of Quality Health Services
- Commission Nationale de Lutte contre le SIDA
- Luxembourg Development (LUXAID)
- Médecins Sans Frontières
- Treatment and Research on AIDS Centre
- Clinton Foundation
- Family Health International/IMPACT
- International Rescue Committee
- National Malaria Program
- PRIME II
- United Nations Children's Fund (UNICEF)
- World Health Organization
- For HIV/PMTCT-Plus, 15 sites in 7 of 39 districts the first year
- For malaria, four districts
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Since 1999, QAP has been working in South Africa on accreditation for hospitals, focused accreditation of youth-friendly services, and improving the quality of Maternal and Child Health (MCH), Tuberculosis, and HIV services in selected districts of Mpumalanga Province. QAP is also working to improve compliance with evidence-based guidelines for such high-priority clinical services as HIV, PMTCT, Tuberculosis, and Maternal and Neonatal Care. In 2003, QAP was asked to expand its assistance to KwaZulu-Natal, Limpopo, Eastern Cape, and North West Provinces.
Institutionalize quality assurance system at various levels of the health system in the Mpumalanga, KwaZulu-Natal, Limpopo, Eastern Cape, and North West provinces
Develop and implement training in quality methodology, including quality control (standards and monitoring), problem solving, and design, targeting priority clinical services, including HIV, STI, TB, maternal and child health
Assist Provincial Departments of Health to improve compliance with standards of care for priority clinical services through job aids, refresher training, process redesign, and team-based quality improvement
Assist the National Department of Health in identifying and communicating "best practices" through occasional symposia and newsletters
National Department of Health
Provincial Departments of Health and EQUITY Project
Local NGOs and universities
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With PEPFAR funding, QAP is collaborating with the Regional Health Office in Dar es Salaam, Tanzania, to implement an improvement collaborative, involving nine facilities initially, on the treatment of Pediatric AIDS in the region. QAP has facilitated adaptation of available international and regional guidelines, including the training curricula both for pre-service and in-service providers, for the care of children infected and affected by HIV/AIDS.
QAP has also worked with the MOH and participating hospitals to conduct an Infection Prevention Improvement Collaborative among the three district hospitals in the region of Dar es Salaam. The project applied the WHO/AFRO Policies and Guidelines for Infection Prevention developed for sub-Saharan Africa.
- Develop a Hospital Improvement/Pediatric AIDS Treatment Collaborative
- Implement adequate standards of care for pediatric patients infected and affected by HIV/AIDS
- Develop job aids for infant feeding and Prevention of Mother-to-Child-Transmission of HIV (PMTCT)
- Conduct a study of health worker stigma related to HIV/AIDS
- Chief Regional Medical Officer, Dar Es Salaam
- Administrators and department heads at participating hospitals
- Aga Khan Hospital
- Management Sciences for Health
- Nine hospitals in Dar es Salaam region