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Continuous Quality Impovement for HIV/AIDS services

last updated Sep 28, 2011

Overview

Implementing organization: 
Referral Hospital
Implementation Partner(s): 
National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases (NCHADS) and NGOs
Legal Status: 
State/government
Year Launched: 
2008
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Government
Additional Source(s) of Funding: 
Donor

Scale

Personnel Employed: 
100<
Summary: 

Continuous Quality Improvement (CQI) is a mechanism that was developed by Cambodian government through National Center for HIV/AIDS & Sexually Transmitted Diseases and Dermatology (NCHADS) since 2008 to monitor the quality of continuum of HIV/AIDS care services.

Program goals/rationale: 

While HIV/AIDS burden was widely known to have potentially negative impacts on people’s well-being, economy and society in late 1990s, Cambodia was struggling to combat this disease by desperately applying some curative and preventive interventions, with huge investment of resources to decrease the virus transmission and improve the quality of lives of PLHA. The expansion of the HIV/AIDS care and treatment program has started since late 2003, with the use of Continuum of Care (CoC) approach. When the program had grown bigger to cover various parts of the country, the quality of HIV/AIDS service delivery considerably put on concern. The larger coverage the program can reach it does not always translate the better results we will get. It would be great if the large-scale program proceeds on right track with good results but if this big program goes with a little or poor outcomes, there would be a huge wasting of resources. The implementation of CQI aims at ensuring the availability and quality of CoC services for PLHA at referral hospitals through the continuously tracking and revising the implementation progress, and engaging relevant stakeholders to participate in addressing some challenges that may hinder the progress of the service provisions.

Key program components: 

Cambodia has applied a concept of Plan, Do, Check and Act (PDCA) as a guide for CQI implementaton which proceeds in 6-month cycle basis. NCHADS takes responsibilities for carrying out the process of PDCA by sending its staff to conduct field work plan review and analysis for root causes, and mobilize resources for recommendation implementation.

Mortality Indicators (MI), Quality Service Indicators (QSI), and Case-finding and Prevention Indicators (CPI) are used as principle indicators for prioritization. Each principle indicator contains sub-indicators which deeper detail key information translating the status of CoC procession.

Field assessment led by NCHADS normally lasts for one to two weeks. For each site, there may be some various indicators translating challenges at different priorities. However because of limited resources, CQI process intends to choose and address only 3 main challenges which potentially contribute to the improvement of CoC services. Importance, Urgency and Feasibility are applied as main criteria to prioritize and choose the 3 main challenges from all relevant challenges. Importance is indicated for any challenges that have highly potential impacts on the quality of CoC; Urgency is indicated for those challenges that need to be immediately addressed otherwise their impacts may expose the CoC at disaster and Feasibility means for those challenges that can possibly be addressed in effective ways. In general, three principle determinants including Patients, Service Providers and Systems are closely involved in the 3 main challenges. The process of analysis is vigorously performed to find out the root causes of the 3 main challenges in correlation with the three principle determinants. When the root causes are identified, the recommendations for solutions are proposed in correspondence with the causes. A plenary workshop is finally organized to present and discuss the findings of the assessment, and engage health providers and development partners to mobilize resources to translate the recommendations into actions toward the identified issues.

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Developement Process of SOP for CQI Cambodia.pdf355.49 KB
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