title: Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia.
abstract: BACKGROUND
  The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation.
  
  
  METHODS
  Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata.
  
  
  RESULTS
  24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20-1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24-1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings.
  
  
  CONCLUSIONS
  QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation.
authors.affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Koni
authors.affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Chishinga
authors.affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.
authors.forename: Lameck
authors.initials: L
authors.lastname: Nyirenda
authors.affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.affiliation: Cardno, PO Box 320303, Lusaka, Zambia.
authors.forename: Richard
authors.initials: R
authors.lastname: Nsakanya
authors.affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.
authors.forename: Michael
authors.initials: M
authors.lastname: Welsh
mesh_terms: D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy* / Q000635:transmission; D006268:Health Facilities / Q000592:standards; D006290:Health Planning Technical Assistance; D006801:Humans; D008297:Male; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards; D014481:United States; D054702:United States Agency for International Development; D019037:Urban Health Services / Q000592:standards; D015024:Zambia