Abstract
IntroductionZambia’s under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level.Description of implementationThe project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia’s Lusaka Province. We have deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. We also engage community health workers to actively refer and follow up patients.Evaluation designProject implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. Three annual household surveys will determine population estimates of age-standardized mortality and under-5 mortality in each community before, during, and after implementation. Surveys will also provide measures of childhood vaccine coverage, pregnancy care utilization, and general adult health. Health facility surveys will assess coverage of primary health interventions and measures of health system effectiveness.DiscussionThe patient-provider interaction is an important interface where the community and the health system meet. Our project aims to reduce population mortality by substantially improving this interaction. Our success will hinge upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognize their value and begin to utilize them.
Highlights
Zambia’s under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction
A high burden of pregnancy and perinatal complications, childhood diseases, cardiovascular and other non-communicable diseases, accidents, and infectious diseases, such as AIDS, tuberculosis, and malaria contribute to a life expectancy for the average Zambian of just 48 years [2,3]
Some health indicators have improved over the past few years [12,13], overall progress must accelerate substantially if Zambia is to meet its targets for the health related Millennium Development Goals (MDGs) [14]
Summary
The goal of our project is to measurably reduce mortality rates in a large, predominately rural population in Zambia. We aim to achieve this through a health systems intervention that puts delivery of high-quality, standardized, and monitored clinical care at its center. At this stage, the BHOMA team can report on key implementation successes and adaptations that have improved our approach to reducing mortality rates. Collaboration and partnership We have successfully leveraged the substantial infrastructure and resources available through other programs sponsored by our group (e.g., support for HIV/AIDS care and treatment services) in the target districts This has fostered trust and familiarity between project teams and regular Ministry of Health providers at the implementation sites. Competing interests The authors declare that they have no competing interests
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