What We Do

Drawing upon its 20+ year history of implementing and managing a government-led quality management program in New York State and now as part of UCSF Institute for Global Health Sciences.

HEALTHQUAL utilizes diverse strategies to advance the improvement goals of each participating country.

  • QI collaboratives
  • Coaching and mentoring of MOH staff and officials
  • Peer and south-to-south exchange
  • Consumer involvement at local and national levels
  • Knowledge management strategies
  • Quality resource development and dissemination
  • Development of national quality plans

Engagement of the Ministry of Health
HEALTHQUAL has demonstrated success in partnering directly with Ministries of Health and gaining buy-in and participation from senior leadership and key stakeholders within the Ministry, which optimizes successful integration of the Quality Management Program into Ministry structures. This is particularly important as countries move to adopt national strategic plans and formal national QI/QA policy, and as Ministries of Health plan for the integration of disease-specific programs (e.g. HIV) into the broader public health care delivery system.

Current Activities

Quality Improvement Collaboratives

Improvement Collaboratives are a formal methodology that accelerate improvement in an area where a gap in performance has been identified. Collaboratives are fast-paced, time-bound initiatives with specific goals, few standard measures, frequent reporting of data, working participation, and peer exchange that fosters a culture of “all teach, all learn”.

HEALTHQUAL has launched five improvement collaboratives, including:

  • Namibia: Project on Retention of Patients on ART (NAMPROPA)
  • Zimbabwe: ART4All
  • Nigeria: All Kids Count
  • Southeast Asia: Stigma Reduction
  • Malawi: Linkage and retention

Capacity building for performance measurement and using data for improvement

Since inception, HEALTHQUAL has facilitated development of national adult and pediatric HIV and well-child quality indicators in 15 PEPFAR countries comprising approximately 900,000 patient chart reviews representing assessment of quality provided to hundreds of thousands of patients.

Performance measures have included viral suppression, viral load (VL) and CD4 monitoring, antiretroviral therapy (ART) initiation, tuberculosis (TB) screening and treatment, prevention of mother-to-child transmission (PMTCT), clinical visit monitoring among others.

Through application of the HEALTHQUAL approach to performance measurement in eight countries, improvement has been demonstrated between baseline and most re­cent follow-up mean clinic scores in 100 of 133 indicators across adult and pediatric HIV programs and in Guyana’s Well Child program for HIV-negative children. Read the Performance Measurement Data Report.

HEALTHQUAL Multi-Country Learning Network (MCLN)

HEALTHQUAL has successfully built a virtual multi-country learning network of senior Ministry of Health leadership and staff representing six countries on three continents. The network focuses on topics related to building capacity for national quality management programs and achieving 90-90-90 targets. These facilitated sessions harness real-time knowledge of QM implementation and systems for ongoing communication to catalyze and accelerate spread of knowledge, leading to the growth and sustainability of an ongoing learning community.

Read about HEALTHQUAL's Multi-Country Learning Network activities

QI Coaching and Mentoring for Sustainable National QM Programs

A critical marker of a sustainable QI program is the widespread integration of QI principles and tools into the routine work of planning, leading and delivery of care in a given context. A QI coach offers adaptable expertise in the organizational applications of QI with the goal of moving the QM program toward full and sustainable implementation. A growing cadre of skilled individuals becomes a prerequisite for greater geographic reach, especially critical as the countries identify successes and quickly want to build upon them.

Specific coaching functions, responsibilities and expertise are described in the HEALTHQUAL Coaching Toolkit.

Coaching Certification

QI Coaching is a key component of the HEALTHQUAL model that can enhance the successful implementation of a national QM program. By integrating QI coaching throughout the system, the national program strengthens the capacity of facilities to implement QI, escalate and overcome challenges and improve performance on national goals. In addition to the knowledge needed on QI and coaching, staff need defined coaching roles and responsibilities to ensure their knowledge is put into practice and is in line with the national QM program’s goals and objectives.

HEALTHQUAL, working with national QM programs in Haiti, Zimbabwe and Namibia, has developed QI Coaching Certification Standards. These standards define specific QI Coaching knowledge and skill criteria that acknowledge a higher level of coaching expertise and set an expectation to conduct consistent coaching processes on behalf of the national program. The national program is responsible to implement the certification program including a regular skills assessment and re-certification after a defined period to ensure the coaching role is sustained. Staff who meet the criteria for QI knowledge and coaching skills become Certified QI Coaches by the national program.

Read about the Coaching Certification Program

National Organizational Assessment

Institutionalizing QI within Ministries of Health has been a major objective and success of HEALTHQUAL. The National Organizational Assessment (NOA) is the only tool known to us designed to measure the progress of national Quality Management programs as they advance toward sustainability and institutionalization. The NOA addresses elements of governance and systems for quality necessary to institute an effective, sustainable national HIV QM program:

  • Leadership
  • Quality Management planning
  • Human resource management
  • Patient and community involvement
  • Performance measurement
  • Organizational infrastructure
  • Capacity building
  • Attention to patient outcomes

In HEALTHQUAL countries, linear regression estimates of NOA results indicate a statistically significant improvement in progress along the continuum of achieving institutionalization.