Assessment of functionality of quality improvement teams and linkage of HIV positive mothers into HIV chronic care in Uganda

Abstract

Introduction: The rapid scale up of HIV/AIDS services in Uganda has put more demand on the health units which calls for health unit based teams to regularly identify gaps in service delivery and find possible solutions. Ministry of Health and her partners responded to this by setting up quality improvement teams at selected health units to address these challenges however; their performance has not been assessed. Objective: To assess the functionality and performance of HIV clinic quality improvement teams at sixteen HIV clinics in Central and Western Uganda. Methods: This was a cross sectional study using a systems analysis approach, conducted at sixteen HIV clinics with QI teams in Central and Western Uganda. Data was collected from QI team leaders at sixteen HIV clinics in Central and Western Uganda using a standard questionnaire, extraction of records and by observation. Functionality was assessed using a composite indicator and health unit performance was determined using trend analysis. Results: Quality improvement teams were formed at all the sixteen health facilities and 71% of them had all the sections of the clinic represented on the team. Laboratory technician/assistants were the commonest members on the team and were present at 94% of teams. Receptionists were the least represented with only 37% of all the teams having them. At 43% Clinicians were the commonest cadres that dropped out after team formation. The percentage of QI team meetings deemed successful declined from 96% in the first quarter to 56% in the fourth quarter after team formation. The least performing component of functionality was QI team activeness at 54.1% while the best performing component was use of data tools at 86.5%. Overall, the average functionality of teams was 74.8% and 63% of the QI teams were functional with all the HCIIIs being functional. QI teams significantly improved the linkage of HIV positive mothers from an average of 25% before team formation to70% after 12 months of their existence (p<0.001). The performance of QI teams in linkage of HIV positive mothers into HIV care was associated with team functionality. There was no difference in performance based on the type of coach supporting the team. Conclusions: Quality improvement team activeness was the biggest hindrance to QI team functionality. QI teams significantly improved the linkage of HIV positive mothers into HIV chronic care at sixteen HIV clinics. The performance of quality improvement team is positively related to the team functionality. Health unit performance did not depend on the type of coach supporting the team. Recommendations: Health units should have integrated meeting in which quality improvement issues are addressed rather have separate QI meetings as way to address poor team activeness. The Ministry of Health should spread the quality improvement approach to all HIV clinics in the country and to other technical areas other than HIV care.