Improving performance of Zambia Defence Force antiretroviral therapy providers: evaluation of a standards-based approach

Abstract

A detailed standards-based performance approach modestly improved providers' performance and facility readiness to offer antiretroviral therapy. The approach included mutually reinforcing activities: (1) training, (2) supportive supervision, (3) assessments of service quality, and (4) facility-based action plans.

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

“…Two separate analyses of providers' performance during ART and PMTCT consultations [11,12] have found similar patterns. In both cases, performance started out at a similar level in the two study groups, but scores increased more at intervention than comparison sites (Fig.…”

“…In practice, however, teams also have been able to use the results of facility assessments to lobby for external support to resolve critical barriers to the quality of services [22]. At ZDF facilities, staff teams sought and received funding from the Defence Force Medical Services and donors for the construction of maternity wards [12] and they convinced military commanders to change the demands placed on military medical assistants so they could devote all of their time to healthcare [11].…”

“…A brief summary of the methods is presented here. For a full description of the study design, sampling, and data collection, see the articles by Kim et al [11,12] and Bazant et al [13].…”

“…The analyses of facility readiness include 8 standards for ART services and 10 standards for ANC/PMTCT services (see Table 1) [11,12]. The overall ART readiness score declined slightly in both study groups (Fig.…”

“…A 2012 evaluation of SBM-R's effectiveness examined facilities' readiness to offer goodquality HIV-related services and the actual quality of the services offered. Previous articles have reported the evaluation's findings on ART services [11]; antenatal care (ANC), including PMTCT, services [12]; and the work environment [13]. This study presents selected data from those articles and synthesizes the findings to provide a fuller picture of the SBM-R approach to quality improvement at ZDF facilities, its effects, and the lessons learned.…”