Approaches to Sustainability of Quality Improvement Interventions in HIV Care at Selected Health Facilities in Buikwe District .

Abstract

This study explored approaches to sustainability of health care quality improvement interventions in HIV care at five selected health facilities in Buikwe district. There was a total of sixty respondents that were different health cadres who had participated in the quality improvement programme as of the end of December 2013. The study utilised both a qualitative and quantitative study design in order to understand the common service delivery organisation approaches that were used to sustain quality improvement gains, determine the extent to which patients were involved in sustaining quality improvement approaches. Findings indicated that involving patients in care such as in decision making, helping fellow patients navigate through care, registration of patients, health education was the most common approach that enabled health care providers to sustain quality HIV care. This was stated by 36 (60%) of the respondents. Making changes in the way services are provided was also key in sustaining improvement gains. It included such approaches like: 1) training to equip health workers with knowledge and the most common training was one in quality improvement approaches reported by 33% of the respondents. 2) making changes to ensure that patients drugs are available by making timely orders to the national medical stores or joint medical stores, patients records are used to inform decision making to treat patients treated well, strengthening facility/community linkages through integrated outreaches were among other service delivery changes to sustainability of improvement gains. These interventions were implemented through a P-D-S-A approach lens as mentioned by 73.3% of the respondents. Provision of incentives was not a motivating factor to sustain quality improvement gains. Majority of respondents (80%) had not received any incentive but continued to provide quality HIV care. This study is a show case of the significance of a patient centred care approach especially whenfocusing on improving care for patients with chronic conditions. It further gives evidence about different service delivery organisation approaches that should be applied to improve other areas of health care. Sustaining improvement gains therefore requires involving consumers of health care-patients, to provide care as expert of themselves and re-designing care so that it is provided in the most effective manner that meets patients’ expectations.