title: Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.
abstract: Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.
authors.affiliation: aZamni LaSante, Port au Prince bDirection Sanitaire de l'Artibonite, Haiti, Gonaives cDepartment of Global Health and Social Medicine, Harvard Medical School dAriadne Labs ePartners in Health, Boston, Massachusetts, USA.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Joseph
authors.forename: Gregory
authors.initials: G
authors.lastname: Jerome
authors.forename: Wesler
authors.initials: W
authors.lastname: Lambert
authors.forename: Patrick
authors.initials: P
authors.lastname: Almazor
authors.forename: Colette Eugene
authors.initials: CE
authors.lastname: Cupidon
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care / Q000458:organization & administration*; D037001:Directive Counseling; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D006205:Haiti / Q000453:epidemiology; D006292:Health Priorities / Q000458:organization & administration*; D006295:Health Resources; D006301:Health Services Needs and Demand; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015596:Nutrition Assessment; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D059039:Standard of Care; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*