A Quality Improvement Intervention to Inform Scale-Up of Integrated HIV-TB Services: Lessons Learned From KwaZulu-Natal, South Africa

Gengiah, Santhanalakshmi; Naidoo, Kogieleum; Mlobeli, Regina; Tshabalala, Maureen Fatsani; Nunn, Andrew; Padayatchi, Nesri; Yende‐Zuma, Nonhlanhla; Taylor, Myra; Barker, Pierre; Loveday, Marian

doi:10.9745/ghsp-d-21-00157

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…We also concur that more general leader traits can be associated with well-performing teams, including getting member buy-in [ 51 ]; being able to delegate tasks and valuing member contributions [ 23 , 24 ]; and an awareness that members had different personalities and needed to be treated differently in certain circumstances. [ 51 ] Yet, the leader’s enthusiasm must be supported by senior personnel in the facility, as cited in a QI programme that improved TB-HIV services, as one of the reasons for its success [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…HCWs generally deliver care in teams and therefore QI effectiveness is related to team effectiveness, with the team leader instrumental in how well the team performs [ 17 , 18 ]. Though the late 1980’s saw a focus on leadership in public health [ 19 ], many of its current theories share constructs developed in other fields, for e.g. a leader’s integrity and self-confidence are as desirable in healthcare [ 20 ], as in commerce [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Odendaal,

Chetty,

Tomlinson

et al. 2023

BMC Health Serv Res

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The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants’ experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders’ attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members’ mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Odendaal,

Chetty,

Tomlinson

et al. 2023

BMC Health Serv Res

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“…Extension for Community Health Outcomes-like models, combined with telepathology, are high potential for APS-efforts for diagnostic quality improvement and education, especially as the COVID pandemic has accelerated the adoption of digital diagnostic APS in UMHICs (35). To date, telepathology efforts have been used to provide diagnostic support from a UMHIC collaborator to an LMIC site (36). A small External Quality Assurance (EQA) in diagnosis for APS for LMICs (Ghana and Nigeria) hosted by Leeds University is also reported (37) (the authors were unable to access the further data about this program).…”

Section: Develop Resource-stratified External Quality Assurance and Q...mentioning

confidence: 99%

“…These have been used in a variety of specialties, often across geographic borders. They have been instrumental in improving infectious disease care (particularly tuberculosis and human immunodeficiency virus care) (36). The existing structures are now being leveraged to expand the initiatives to non-infectious diseases with the hopes of accelerating the time to achieving the non-infectious disease SDGs (38).…”

Section: Develop Resource-stratified External Quality Assurance and Q...mentioning

confidence: 99%

Addressing quality and safety in anatomic pathology in low- and middle-income countries

Smith

Eadara²,

Parkash³

2022

Front. Med.

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The World Health Organization (WHO) has created a sustainable development goal of reducing preventable mortality from cancer in low- and middle-income countries (LMICs) by 30% by 2030. Central to achieving this goal is the creation and maintenance of quality anatomic pathology services (APS). Within the last decade, quality assurance programs and patient safety measures have become a major focus of research for upper middle- and high-income countries (UMHICs), which has led to marked documented improvement in the quality of services provided by laboratories, as well as a decrease in patient safety events. We propose that as APS are developed in LMICs, the lessons learned by UMHICs are necessary to incorporate to produce quality and safe services toward obtaining the aforementioned goal. Furthermore, data suggests that Quality Improvement work requires change at the macrosystems and microsystems levels to achieve these goals. Here, we propose five “microsystems” strategies for professional organizations, healthcare institutions in LMICs and UMHICs that would accelerate quality improvement programs/systems implementation in APS in LMICs.

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“…Although South Africa has implemented continuous quality improvement to consistently assess the performance of TB and HIV services [ 20 , 21 ], to our knowledge, no assessments of TB services have been published since the start of the COVID-19 pandemic. For this reason, the study aimed to assess the quality TB diagnostic services at primary healthcare clinics (PHCs) in the eThekwini district, South Africa.…”

Section: Introductionmentioning

confidence: 99%

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

Dlangalala,

Musekiwa,

Mashamba-Thompson

2024

PLoS ONE

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Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson’s pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.

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A Quality Improvement Intervention to Inform Scale-Up of Integrated HIV-TB Services: Lessons Learned From KwaZulu-Natal, South Africa

Abstract: Despite being standard of care, gaps in HIV-TB service delivery are present. Quality Improvement methods are effective in uncovering health systems weaknesses that impede efficient delivery of integrated HIV-TB services.

Cited by 4 publications

References 28 publications

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Addressing quality and safety in anatomic pathology in low- and middle-income countries

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

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