Quality and Quality Improvement
CQUIN focuses on both differentiated service delivery (DSD) coverage and quality. The CQUIN Dashboard tracks DSD coverage in network countries, all of which have shown notable progress in expanding geographic coverage and the proportion of eligible people enrolled in differentiated ART (DART) models. The dashboard also tracks quality – and most network countries have documented a marked lack of data in this domain. Early programmatic experience highlights the need for close attention to DSD quality challenges including imperfect use of DSD eligibility criteria; suboptimal utilization of viral load data; changes to program design that discourage enrollment; and lack of fidelity to DSD guidelines.
In response, CQUIN has launched a community of practice focused on quality and quality improvement, engaging network participants in a series of in-person workshops and an ongoing virtual collaboration. In June 2019, CQUIN hosted an all-network workshop on DSD Quality and QI, and the network continues to explore each of the three elements of the classic “Juran Triad” as they relate to DSD – quality planning, quality assurance, and quality improvement.
Quality planning asks: “What is the quality standard?” and establishes goals and targets for health system performance. While all CQUIN Network countries have national DSD policies and guidelines, and many have targets for DSD coverage, fewer have specific standards for DSD quality. The CQUIN Quality & QI community of practice has developed a quality standard framework for DSD models and is working on relevant indicators.
Quality assurance asks: “Are we meeting the standard?” and measures performance against targets. The CQUIN Quality and QI community of practice continues to explore different countries’ approach to DSD-specific QA (including related indicators and data sources) and the extent to which their growing DSD programs meet quality standards.
Quality improvement asks: “How can we continuously improve performance?” Key elements include identification of a quality challenge, root cause analysis, identification and prioritization of interventions, selection of indicators, and rapid, iterative tests of change. CQUIN has conducted a series of workshops and trainings on QI-for-DSD, and the Quality & QI community of practice continues to exchange updates, outcomes and resources related to QI-for-DSD projects.