title: Monitoring quality at scale: implementing quality assurance in a diverse, multicountry HIV program.
abstract: The centrality of quality as a strategy to achieve impact within the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has been widely recognized. However, monitoring program quality remains a challenge for many HIV programs, particularly those in resource-limited settings, where human resource constraints and weaker health systems can pose formidable barriers to data collection and interpretation. We describe the practicalities of monitoring quality at scale within a very large multicountry PEPFAR-funded program, based largely at health facilities. The key elements include the following: supporting national programs and strategies; developing a conceptual framework and programmatic model to define quality and guide the provision of high-quality services; attending to program context, as well as program outcomes; leveraging existing and routinely collected data whenever possible; developing additional indicators for judicious use in targeted, in-depth assessments; providing hands-on support for data collection and use at the facility, sub-national, and national levels; utilizing web-based databases for data entry, analysis, and dissemination; and multidisciplinary support from a large team of clinical and strategic information advisors.
authors.affiliation: aICAP at Columbia University, Mailman School of Public Health bDepartment of Epidemiology, Columbia University Mailman School of Public Health cDepartment of Medicine, Columbia University College of Physicians and Surgeons, New York, USA dICAP in Kenya, Nairobi, Kenya eICAP in Mozambique, Maputo, Mozambique.
authors.forename: Suzue
authors.initials: S
authors.lastname: Saito
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Duncan
authors.initials: D
authors.lastname: Chege
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Ellman
authors.forename: Laurence
authors.initials: L
authors.lastname: Ahoua
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
authors.forename: Miriam
authors.initials: M
authors.lastname: Rabkin
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D037001:Directive Counseling; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D058016:Health Facility Administration / Q000592:standards* / Q000639:trends; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000639:trends; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007391:International Cooperation; D009313:National Health Programs; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D059039:Standard of Care