title: A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa.
abstract: QUALITY PROBLEM AND ASSESSMENT: In South Africa (SA), non-governmental organizations (NGOs) have a major role in the provision of health services, but they often compete for funding and influence rather than collaborate. The National Department of Health (NDOH) sought to coordinate existing non-governmental organizations (NGOs) to optimize the prevention of mother-to-child HIV transmission (PMTCT) at scale.
  
  
  METHODS
  We describe how a group of NGO and government partners were brought together to jointly develop the 'Accelerated Plan' (A-Plan) to improve PMTCT services at health-care facilities in SA. The A-Plan used four main principles of large-scale change to align the network of NGO partners and NDOH: setting targets and improving data, simplifying processes and facilitating local execution, building networks and enabling coordination.
  
  
  METHODS
  In the first 6 months of the project, six NGO partners were engaged and the program reached 161 facilities. The program spontaneously spread from five planned subdistricts to nine subdistricts and produced a package of tested interventions to assist in scale-up of the PMTCT program elsewhere.
  
  
  RESULTS
  Districts reported high levels of provider engagement in the initiative. In the 6-month project period, a total of 676 health-care workers and managers were trained in quality improvement methods and tools. Coverage of seven key processes in the PMTCT program was tracked on a monthly basis within each subdistrict.
  
  
  CONCLUSIONS
  We found that a network model for the A-plan could successfully recruit key stakeholders into a strong partnership leading to rapid scale-up of a life-saving public health intervention.
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA. kmate@ihi.org
authors.forename: Kedar S
authors.initials: KS
authors.lastname: Mate
authors.forename: Gugu
authors.initials: G
authors.lastname: Ngubane
authors.forename: Pierre M
authors.initials: PM
authors.lastname: Barker
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D010346:Patient Care Management / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D013019:South Africa / Q000453:epidemiology
keywords: HIV; PMTCT; South Africa; implementation; scale-up