Background: Continuous Quality Improvement (CQI) in health care is a systematic approach to making changes that lead to better patient outcomes and stronger health system performance. This approach involves the application of CQI, which provides robust structure, tools and processes to assess and accelerate efforts to test, implement and scale up. CQI is the complete process of identifying, describing and analyzing strengths and problems and then testing, implementing, learning from and revising solutions and spreading good practices. The USAID ASSIST project has been implementing CQI for VMMC programs in South Africa since June 2014.
Description: Over 100 VMMC sites received baseline CQI assessments to determine the existing service delivery levels. The quality gaps identified formed a basis for introducing CQI methodology (identify, analyze, develop and test and implement and PDSA cycles). At all sites, CQI teams were set up, comprising site-level staff. Monthly and quarterly CQI mentoring and coaching visits were conducted by ASSIST staff at sites, according to performance. CQI site teams were mentored on analyzing, reviewing data, documenting program performance and problem solving.
Lessons learned: Using CQI methodology and tools, all site teams started documenting programmatic data, compiling common quality indicators, analyzing quality gaps and discussing possible interventions. All sites are seeing an improvement in documentation of their client follow-up rate since they began plotting indicator changes on the graphs. Eighty three sites showed significant improvement in 48 hour client follow up, from 28.1% to 47.5% between February - December 2015.

Percentage of 48 hour follow up of VMMC clients in 83 CQI facilities
[Percentage of 48 hour follow up of VMMC clients in 83 CQI facilities]

Conclusions/Next steps: Since the onset of CQI support, it has been noted that site level CQI teams have gained a positive attitude and are motivated to develop interventions and site-level action plans. While shown to be effective within the VMMC program, CQI tools and methodologies can be applied to all health programs as teams can implement skills gained and lessons learnt across board.

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