Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.
Background: Under USAID funded RESPOND project, a collaborative Quality Improvement (QI) effort was initiated in March 2013 with two detention centers and an Anti-retroviral treatment (ART) site in Odessa; their respective aims were to improve the HIV continuum of care among the rural population and to increase the coverage of detainees with HIV Testing and Counseling (HTC) services and enrolment in care. Before the improvement effort, in 2012, only 3.0% of detainees received HIV counseling, of which 19.2% were tested for HIV. Furthermore, there was no reliable mechanism to link released HIV-positive detainees with ART services.Methods & Materials: The three sites applied a Plan-Do-Study-Act QI Model to test changes; this model included teamwork and coordination with the Odessa AIDS Center; monthly selfmonitoring against improvement indicators, QI coaching visits, and sharing results during quarterly learning sessions. After 12 months of implementation, a data review and qualitative assessment survey were conducted.Results: Over one year, the two detention centers increased the coverage of HIV counseling services for detainees from 44% to nearly 70% . The coverage of HIV testing increased on average from 32% to 70%. The percentage of detainees that tested positive who were enrolled in care with the AIDS Center increased from 0% to 40% after introduction of health system changes.The ART Center increased the proportion of HIV patients enrolled into care within 30 days after the confirmatory HIV test from 55% to 70% . The percentage of patients that underwent regular checkups increased from 42% (June 2013-October 2013) to 80% Conclusion:The key results of the project were the following: for the Odessa ART Center -1) increased timely enrolment of HIV positive individuals in care, and 2) improved attendance of HIV positive patients at regular check-ups; and 3) increased coverage with HTC services. These results indicated that more people were diagnosed with HIV at an earlier stage and more of them were enrolled in care in a timely manner and benefitted from the known efficacy of ART.
The article deals with the problem of the formation of professional communicative annotation skills using audio-visual technologies. The definition of professionally directed annotation is formulated. The relevance of the proposed article lies in the fact that it presents a scientifically-based method of forming the skills of professional communicative annotation of audiovisual texts in Russian. The purpose of the article is to substantiate the general methodology, law, and principles for integrating the content of vocational education in the context of a competence-based approach. Materials and methods: used integration, cognitive, competence approaches, the method of comparative analysis. Results of the research: in the course of the research, the concept of the term “annotation”, the annotation skills of an audio-visual text, the method of forming the skills of professional communicative annotation of audio-visual texts: scientific or popular science films in Russian are defined.
Currently, Cambodia uses performance-based financing (PBF) and a national quality enhancement monitoring system as key components of its strategy to achieve universal health coverage and the health-related Sustainable Development Goals. PBF is one among many strategies to improve the quality of healthcare services and its effects and limitations have been widely documented. We share lessons learnt from the use of quality improvement collaboratives, a facility-based quality improvement strategy, to amplify and complement PBF to address specific service delivery gaps, improve provider competency, and increase patient trust and satisfaction in the health system, a driver of healthcare utilisation.
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