The African Center for Global Health and Social Transformation(ACHEST) hosted a talk on quality improvement in health care. This is part of the work that ACHEST is doing on behalf of the Ministry of Health to implement the Clinical Skills Update and Mentorship in Reproductive, Maternal New Born, Child and Adolescent Health (RMNCAH) in eastern Uganda.
The session held virtually on August 25, 2021, was attended by several participants including specialists, general practitioners, midwives, nurses, district health leaders, and administrative leaders among others.
The ACHEST Director of Medical Education and Development, Elsie Dr. Kiguli-Malwadde told participants that the overall goal of the project is to end the needless maternal and newborn deaths; and improve the quality of life of the children, adolescents, and women in Uganda as stated in the RMNCAH Sharpened Plan.
The general objective is to work with the health professions associations and regional referral hospitals to provide clinical mentorship so as to ensure that health worker's clinical skills are improved. In the end, this will result in improved quality of health care.
The ACHEST Executive Director Prof. Francis Omaswa gave a detailed presentation on the philosophy and practice of the quality of health care.
He stressed from the onset that that quality is about the pursuit of excellence. “Everything you do can be done even better than you have done today. Make a plan and look at how you will do better today, or next month or next year than you did before,” said Prof. Omaswa
Prof Omaswa who is also the former Head of the Quality Assurance Program and Director General of Health Services in the Ministry of Health Uganda, detailed the history of how the quality assurance programme was established (now a Directorate) and highlighted its achievements.
The programme ensured that all district administrative and health leaders were trained in the principles of quality improvement. Standards of service were defined by the level of the health facilities. Regular follow-up meetings were made and everyone knew what they were expected to do.
Prof Omaswa recalled: “We managed to strengthen the capacity of health services, especially under decentralization. The CAO knows what to do, the district leaders picked it very well. We were able to supervise the districts in an integrated way-- specialized supervision, management supervision, and support supervision. High performers were publicly recognized. Overall, the population Out Patients clinics attendances and immunization coverage surpassed the health sector plan targets.”
“This approach works,” stated Prof. Omaswa, but cautioned that without support from the leadership, quality assurance will not happen.
He explained that quality takes different definitions: performance according to standards, meeting the needs of the internal and external customers, doing the right thing at the right time and the right way, and doing the best one can do with the available resources.
He added that continuous quality improvement looks at systems not individuals, a process model that focuses on small individual steps for every process until the result is achieved, data usage to track performance, and building and using cohesive teams of actors.
At all levels, Prof Omaswa highlighted the importance of governance and called for the need to integrate the administrators with the community health workers. This would ease the implementation of the current government programmes such as the Community Engagement Strategy for COVID-19 response as well as the Parish Development Model.
The meeting was moderated by the ACHEST Director of Health Systems, Dr. David Okello. Some of the issues arising from the discussion included|:
• The need to close the communications gap in the governance structure, so that people can know what is expected of them
• Limited supplies and resources affect the way how the health workers work
• Several co-current projects that are being implemented affect workplans.
• Negative attitude from the higher authorities needs to be addressed
• Some health workers developed quality improvement plans such as on the availability of the drug Oxytocin in one of the health facilities.
Compiled by Carol Natukunda