As part of ongoing efforts to improve HIV services in Ethiopia, the Ministry of Health turned to Ghana to learn about new approaches to assessing service quality. Ghana was one of the first two countries to pilot CQUIN’s HIV Program Minimum Package Service Quality Assessment (CQUIN SQA) toolkit.
Between July and September 2025, Ghana assessed 234 health facilities with a first iteration of the toolkit, including those with high HIV caseloads or poor feedback from recipients of care. The results helped Ghana decide which services needed improvement, what training health workers needed, and which facility protocols to update.
To learn from Ghana’s experience, a delegation from Ethiopia’s Federal Ministry of Health visited Accra from August 2 to 6, 2026, for a CQUIN-supported country-to-country learning exchange. The visiting team examined how Ghana adapted and used the toolkit to inform approaches Ethiopia could apply in its own HIV program.
Ghana’s Approach to Quality Management
The exchange began with briefings from Ghana’s National AIDS/STI Control Program and the Ghana Health Service on how the country manages quality at national, regional, district, and facility levels. At each level, designated quality management teams monitor performance, review data, and coordinate quality improvement activities.
At the Greater Accra Regional Health Directorate, the Ethiopian delegation learned how regional teams monitor HIV services, validate data, and provide supportive supervision to health facilities.
At Ashaiman Government Hospital, the delegation learned how the facility uses client satisfaction surveys, clinical audits, and monthly quality management meetings to identify and address gaps in care. At LEKMA Hospital, the team observed how electronic records help track missed appointments, with health workers using phone calls and text messages to follow up with recipients of care. The hospital also uses performance boards to display service quality indicators and track progress.
“At a time when HIV programs must do more with fewer resources, quality management is the backbone that protects performance, guides decisions, and enables recipients of care to continue receiving high-standard care,” said Maureen Syowai, MBChB, MSc, CQUIN program director, on the importance of the visit. “As HIV services are redesigned and increasingly absorbed into routine primary health care, maintaining quality is no longer optional; it is the only way to safeguard continuity of care.”
Key Lessons for Ethiopia
Across the sites visited, the Ethiopian delegation saw how Ghana uses routine program data, supervision findings, and service quality assessments to monitor indicators such as viral load coverage, early infant diagnosis, and retention in care. Equally important was the role of leadership: at each level of the health system, designated teams had clear responsibilities for reviewing performance and coordinating efforts to address gaps in care.
“This learning exchange has reinforced that improving the quality of HIV services is not simply about additional resources—it requires strong leadership, a culture of continuous quality improvement, and the effective use of data,” said Mirtie Getachew, MPH, HIV care and treatment lead at Ethiopia’s Federal Ministry of Health.
From Learning to Implementation
At the conclusion of the exchange, the Ethiopian delegation developed a draft action plan to strengthen quality management within the country’s HIV program. The plan included reviewing and harmonizing existing service quality assessment tools, adapting CQUIN’s SQA toolkit to Ethiopia’s national context, and strengthening health workers’ quality improvement skills through training.
Ethiopia subsequently participated in the second pilot of the SQA toolkit alongside 10 other network countries and presented its findings at a CQUIN Quality Management Community of Practice meeting on October 29, 2026.
