Worldwide
Latin America and the Caribbean
Ecuador
In 2002 QAP completed an operations research study to test a Continuous Quality Improvement (CQI) model that was applied in district hospitals to demonstrate its effects on compliance with Maternal and Child Health (MCH) standards, client satisfaction, and utilization of services. Based on the results, the Ministry of Health (MOH) elected to scale up the CQI model to more districts through the national "Free Maternity Program," a social insurance program that assures provision of a basic package of MCH services to mothers and children. QAP is now supporting the scale-up and institutionalization of the CQI program in eight provinces.
QAP Activities
- Support and describe the process, methods, and results involved in the scale-up of a CQI program within Ecuador's "Free Maternity Program", identifying potential obstacles and options for overcoming them
- Assess the outcomes of the institutionalization process after one year
- Synthesize lessons learned that can be adapted and applied to other QA institutionalization experiences in other LAC countries
Partners
- Ministry of Health of Ecuador
- Free Maternity Program
- Association of Municipal Governments of Ecuador
- National Council of Women
Sites:
- Fourteen initial districts in eight provinces (of 22 provinces in the country)
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Honduras
Since 2001 QAP has provided technical assistance aimed at institutionalizing a comprehensive QA Program with an initial focus on MCH services in Health Region #2. After recognizing significant progress in this region, USAID and the Honduran MOH have elected to expand assistance to a second region. QAP also provides technical support to the central QA Unit of the MOH.
QAP Activities
- Support the Regional Directorate in organizing a QA structure to support continuous quality improvement at the district and hospital levels
- Provide CQI training to district and hospital teams and facilitators
- Provide technical support for the implementation of CQI activities by district and hospital teams
- Advise the MOH QA Unit at the central level on the development of QA policies and the expansion of the CQI model to new sites
Partners
Sites:
- Health Region #2 (Comayagua)
- Health Region #5 (Santa Rosa de Copan)
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Jamaica
QAP has been working in Jamaica since 1998, when invited by USAID/Jamaica to help the National Family Planning Board update its clinical guidelines for family planning. QAP also provided support for the dissemination of the guidelines and for strengthening the supervision system. In 2001, QAP was asked to help the Ministry of Health (MOH) evaluate the quality of its PMTCT program and then provide support in revising the PMTCT program guidelines. QAP also assisted the MOH to assess the care and support program for people living with HIV/AIDS. QAP continues to provide technical support to the Ministry of Health (MOH) in improving healthcare quality, with a focus on HIV/AIDS.
QAP Activities
- Support quality improvement activities to improve the MOH's PMTCT program at the facility level in three parishes. The improvement package to be implemented at the parish level will include: facility-based refresher training; process redesign; facility-based monitoring of uptake of voluntary counseling and testing (VCT) and Nevirapine; customer satisfaction assessments; and tracking of provider compliance with interpersonal communication and counseling guidelines.
- Conduct a study to follow up some 300 HIV+ women and their infants who received Nevirapine through the MOH's PMTCT program. The study examined the health status/sero-conversion of the infants since their birth, as well as health-seeking behavior and infant feeding practices of the women.
- Provide small grants to Jamaican NGOs to improve the quality of home-based care for people living with HIV/AIDS and work with community health centers to provide quality care and support, including psycho-social and palliative care.
- Assist the MOH in developing national guidelines for the treatment of tuberculosis, which is a growing problem among patients with HIV/AIDS.
Sites
Partners
- Ministry of Health
- CHARES
- Jamaican AIDS Society
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LAC Health Sector Reform Initiative
Overview
QAP supports USAID's LAC Health Sector Reform (LAC HSR) which seeks to improve access, equity, quality, efficiency, and sustainability of the health sector in 13 focus countries in Latin America and the Caribbean. QAP's role in the Initiative is to enhance the impact of health sector reform efforts on improving the quality of healthcare.
QAP Activities
- Field test and refine the PAHO-QAP Analytical Framework for Maximizing Quality of Care through Health Sector Reform
- Document the development of the "Free maternity" law in Ecuador and the legislative process leading to its enactment
- Document the scale-up and impact of the Free Maternity Program in 8 of Ecuador's 22 provinces
- Conduct a review of recent experiences in LAC with accreditation and licensing of health facilities and providers
- Contribute to the LAC HSR website on topics related to quality ad health sector reform
Partners
- Management and Leadership Development Project
- Pan American Health Organization
- Partners for Health Reformplus Project
- Rational Pharmaceutical Management Project
Sites
- The CQI and Health Reform case study is taking place in Ecuador.
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Latin American Maternal Mortality Reduction Initiative (MMRI)
QAP and PAHO are the implementing agencies for the two-year extension of the Latin American Maternal Mortality Reduction Initiative. The purpose of the extension is to scale up facility and community level improvements in access to and quality of essential obstetric care (EOC) to more sites and countries.
QAP Activities
- Adapt the IHI Improvement Collaborative approach to the context of Latin America to implement a multi-country EOC improvement collaborative to establish integrated local EOC systems and achieve significant improvements in quality, access, and demand for EOC in a short period of time
- Work with national officials to develop and implement spread strategies to scale up the improvements from the initial collaborative sites to the entire country
- Disseminate methods and results from the regional improvement collaborative to USAID Missions, cooperating agencies, and other countries in the region through a website, electronically disseminated updates, publications, and regional meetings
Partners
- MOH in each participating country
- Pan American Health Organization
- The Catalyst Project/Pathfinder International
- UNFPA
- UNICEF
Sites
- Ecuador (Tungurahua Province)
- Honduras (Santa Rosa de Copan)
- Nicaragua (SILAIS of Chinandega, Matagalpa, and Bluefields/Atlantic South)
- Peru (Huanuco Region)
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Nicaragua Staff Photo: first row (l to r) are Margarita Sandino, Ivette Rodríguez (holding her daughter Paola) and Ivonne Gómez. Second row (l to r): Luis Urbina and Oscar Nuñez |
Since November 1999 (post Hurricane Mitch), QAP has collaborated with the Ministry of Health to establish a Quality Assurance program based on implementation of standards and indicators of quality of care for maternal and neonatal health services. Initial work in four local health systems (SILAIS) has now expanded to nine of the country's 17 SILAIS. QAP also provides assistance to Profamilia to strengthen QA activities in its family planning clinics nationwide.
QAP Activities
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Institutionalization of Quality Assurance within the Ministry of Health
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Quality monitoring and process improvement of MCH at the primary and second levels of care in 10 SILAIS
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Reduction of maternal mortality through quality improvement related to safe delivery in 10 hospitals
- Improving pediatric care in six hospitals (as part of the Pediatric Hospital Improvement Collaborative)
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Improving emergency care in 8 hospitals (reorganization, process redesign, standards development, and improving client satisfaction)
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Quality improvement activities to reduce perinatal mortality in 10 hospitals in 10 SILAIS
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Consolidation of a comprehensive plan for QA in PROFAMILIA
Partners
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Ministry of Health
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Profamilia
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PAHO
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UNICEF
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Japanese cooperation
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GTZ, Germany
Sites
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Granada SILAIS (four municipalities)
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Boaco SILAIS (six municipalities and the hospital)
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Jinotega SILAIS (eight municipalities and the hospital)
- Matagalpa SILAIS (15 municipalities and the hospital)
- Chinandega SILAIS (seven municipalities and the hospital)
- Nueva Segovia SILAIS (seven municipalities and the hospital)
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Madriz SILAIS (six municipalities and at the hospital)
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Bluefields/Altantic South SILAIS (seven municipalities and the hospital)
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Atlantic North SILAIS (six municipalities and the hospital)
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Since October 2002, QAP has provided technical assistance to Max Saluda Peruvian NGO that provides health services to the urban population of Chiclayo, Peruto develop a continuous quality improvement (CQI) system.
QAP Activities
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Train five CQI teams in Max Salud clinics and management unit
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Develop and disseminate a set of quality standards
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Help CQI teams to monitor compliance with standards, identify gaps, and implement improvement initiatives
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Organize a managerial group to plan and oversee CQI activities
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Design a curriculum for a Diploma course on CQI to be taught at Pedro Ruiz Gallo University, with a practicum to be held at Max Salud clinics
Partners
Sites
- Four clinics in the city of Chiclayo
