Our in-country initiatives in Africa, such as the Ethiopian Health Care Quality Initiative, are designed to address the “burning platform” as defined by the Ministry of Health and the organization that invites us into a partnership. To ensure the sustainability of changes, and to best address the local needs and context of the work, we always partner with local organizations. IHI works with local partners and governments to build their capability to use and teach quality improvement methods from the outset — thus ensuring the sustainability of the methodology.
IHI is also engaged in harvesting and disseminating new ideas and the spread of best practices, both within Africa and to other parts of the world, seeking to influence health policy and the practice of global health. One method of spread we are testing is the use of dynamic learning networks to spread knowledge we acquire from in-country programming while at the same time learning from others.
For example, in South Africa we convened a network of NGOs to support scale-up of the government’s program to prevent mother-to-child transmission (PMTCT) of HIV. IHI also led the Quality Track of the Joint Learning Network for Universal Health Coverage, an initiative of ten low- and middle-income countries in Africa and Asia that are pursuing universal health care access. Learning from both of these networks has been incorporated in our work with the Partnership for HIV-Free Survival. IHI has also collaborated with the Nigerian Ministry of Health to develop a national quality strategy.
Some Highlights of IHI’s Work in Africa
CAPRISA: Using QI to Improve HIV-TB Integration (South Africa)
IHI is excited to provide support to the Centre for the AIDS Programme of Research in South Africa (CAPRISA) in a randomized control study that investigates the use of quality improvement to improve the integration of tuberculosis (TB) and HIV services in selected facilities in KwaZulu-Natal, South Africa. Over the course of the three-year project, IHI will assist CAPRISA in project design, quality improvement capability building, data analysis, and evaluation.
Collaborative Support for Health (Liberia)
In partnership with USAID and Management Sciences for Health (MSH), IHI supports the efforts of the Liberian Healthcare System in improving patient outcomes and access to care for five programmatic areas: maternal and child health; infection prevention and control; family planning; malaria; and HIV/AIDS. IHI’s approach includes working with the Liberian Ministry of Health and the Bong, Lofa, and Nimba counties for developing a National Health Quality Strategy, building QI capability, and leveraging the IHI Breakthrough Series Collaboratives model to improve patient outcomes.
Documentation of Quality Improvement (Uganda)
In partnership with University Research Co. (URC) and the World Health Organization (WHO), IHI is involved in the documentation of Uganda’s Quality Improvement (QI) journey over the last couple decades. This retrospective document will focus on the history and approaches to QI in Uganda, and explore governance strategies and sustainable, effective incorporation of QI within the health care system. This paper will be disseminated in mid-2017.
Ethiopia Health Care Quality Initiative
Since October 2013, IHI has worked in partnership with the Ethiopian Federal Ministry of Health (FMoH), with the support of the Bill & Melinda Gates Foundation and Margaret A. Cargill Philanthropies, to explore how quality improvement (QI) methodologies might accelerate progress of the FMoH to reduce mortality among mothers and newborns. In support of this ambitious agenda, IHI has worked with the FMoH to develop a National Health Care Quality Strategy to create an environment and operational plan to implement the strategy and achieve high-quality care delivery. This includes providing trainings to build QI skills among health care providers at all levels of the health system. IHI has worked with the FMoH to design and implement a district-wide QI intervention, integrating systems improvement with clinical skills building to transform quality through a scalable approach. IHI supports the clinical training, medical equipment support, and on-site clinical mentorship and QI coaching of nurses and midwives to improve the quality of care they provide to mothers and infants in vulnerable communities across 25 districts in the country, with the goal of national scale-up.
Identification and Initiation of Pediatric ART in HIV-Positive Children (Nigeria)
To support the Nigeria Federal Ministry of Health goals, HealthQual Research International and the CDC in Nigeria have partnered with IHI to test the effectiveness of QI methodologies in improving the uptake of Pediatric ART in HIV-infected children in the selected sites (hubs and their referring spoke sites) across the Federal Capital Territory, Nassarawa, and Lagos States. This is being implemented in a total of 10 hub-and-spoke networks across the selected three regions using the IHI Breakthrough Series Collaborative approach.
Improving Preterm Newborn Outcomes (Malawi)
The aim of this project is to reduce mortality of mothers and newborns across 12 identified facilities in Central Malawi by May 2017. We plan to achieve this aim by leveraging QI and IHI’s Breakthrough Series Collaborative model, using a clinical bundle of established clinical protocols, designing and using mHealth data tracking, and developing a change package for spread. IHI’s work is in collaboration with our implementing partner, MaiKhanda Trust, and Malawi’s Ministry of Health through the support of the Bill & Melinda Gates Foundation.
Institutionalizing Quality Improvement (Ghana)
Building on the success of
Project Fives Alive! in Ghana (2008-2015) in reducing mortality in children under five using quality improvement methods, the Bill & Melinda Gates Foundation continues to support IHI’s work in Ghana to further these achievements by focusing on the institutionalization of QI in the health care system at the national level. Over three years (2015-2018), IHI will strive to do this through the development and implementation of a National Quality Strategy and Implementation Plan, including the set-up of a National Quality Strategy Steering Committee within the Ministry of Health to sustainably oversee this effort into the future. In addition to strengthening the infrastructure at the Ministry for Quality Improvement, IHI is also supporting the set-up and success of an independent non-governmental organization, the Ubora Institute, designed to become a leading innovator in QI worldwide.
Partnership for HIV-Free Survival
Partnership for HIV-Free Survival is a six-country initiative — Tanzania, Kenya, Uganda, Mozambique, Lesotho, and South Africa — designed to assist the countries with their current national efforts to improve postnatal HIV, maternal and infant care, and nutrition support through effective implementation of the 2010 World Health Organization Guidelines on HIV and Infant Feeding.
Strategic and Capability Support for HealthQual Collaborative (Namibia)
IHI is excited to provide strategic and technical support for a Collaborative to be conducted in Ondangwa, Namibia, and led by HealthQual International. Through this Collaborative, IHI will assist with the development, capacity building, and facilitation of the IHI Breakthrough Series Collaborative model with the aim of building capacity for QI in HIV care programs and improving patient outcomes in alignment with PEPFAR’s 90-90-90 goals.
Completed Projects and Initiatives
20,000+ Partnership (South Africa)
The aim of the
20,000+ Partnership was to decrease mother-to-child transmission of HIV in 11 districts in KwaZulu-Natal to less than 5 percent by 2011. This work was a partnership between the KwaZulu Natal Department of Health, the University of KZN, and IHI.
A Billion Minds and Lives
Through the support of Sanofi-Aventis Groupe and New York University, A Billion Minds and Lives strives to utilize a continuous quality improvement to bridge the mental health gap at scale, in order to ensure that by 2020, the one billion people in low- and middle-income countries who need mental health treatment receive this care. A consortium of mental health organizations and innovators in Sub-Saharan Africa came together to form a five-country Early Adoptors Network (Ghana, Kenya, Nigeria, Rwanda, and Zambia) to apply quality improvement methods to test and rapidly scale-up effective mental health treatment packages over 18 months, ending in June 2016.
The Aurum Institute (South Africa)
Aurum Institute is a PEPFAR-funded, South African not-for-profit organization to which IHI provided support to improve the prevention of mother-to-child transmission of HIV, and pediatric and perinatal tuberculosis and HIV care in Ekurhuleni North (EKN) sub-district in Gauteng Province and Greater Tubatse and Ephraim Mogale sub-districts in Limpopo Province.
Joint Learning Network for Universal Health Coverage
IHI led the Quality Track of the
Joint Learning Network for Universal Health Coverage, an initiative of ten low- and middle-income countries in Africa and Asia that are pursuing universal health care access.
MaiKhanda, a local Malawian improvement organization, as it worked to reduce maternal and neonatal mortality in three districts across Malawi. MaiKhanda’s initiatives focused on the elimination of mother-to-child transmission of HIV, use of antenatal corticosteroids to reduce deaths due to premature birth, and developing a bundle of best care practices for mother and baby.
Mental Health: Maternal Depression and Epilepsy (Ghana)
Funded by Grand Challenges Canada, this Collaborative of seven hospitals in southern Ghana used quality improvement to address maternal depression and epilepsy. This two-year project (October 2013 to October 2015), led by the National Catholic Health Service of Ghana, had two key aims: 1) Identify 200 women suffering from maternal depression and achieve clinical response within 12 weeks of treatment for at least 50 percent of women identified with maternal depression; and 2) Identify 200 persons with epilepsy and achieve a 10 percent increase in seizure-free days for 50 people who have been treated for epilepsy.
IHI partnered with members of the Health Strategy and Delivery Foundation (HSDF) and the Private Sector Health Alliance (PSHN) of Nigeria to lead three different efforts to increase the use of quality improvement methodologies in Nigeria’s health care sector. IHI provided assistance in the development of strategic leadership and capacity building of Nigerian health care professionals in Nigeria through a national quality strategy, a leadership academy, and a collaborative on maternal and neonatal mortality.
Project Fives Alive! (Ghana)
Project Fives Alive! began in 2008 and ended in 2015. A collaboration between IHI and the National Catholic Health Service, and funded by the Bill & Melinda Gates Foundation, the project worked to assist Ghana in achieving Millennium Development Goal 4 (reducing morbidity and mortality in children under five) and improve the process of referring the mother and child through the care system.
South to South
South to South (S2S), a NGO providing expert pediatric HIV care and training throughout the southern African region, focused on developing a sub-district-based model for pediatric HIV prevention, treatment, and care support program supported by IHI since early 2011. The project, located in the Moretele district in the NW Province, involved 10 primary care facilities and sub-district management, and used an IHI Breakthrough Series Collaborative model to bring the facilities into a Learning Network. Quarterly meetings focused on aspects of the preventing mother-to-child transmission (PMTCT) and HIV treatment pathway in a stepwise way along the progression of the PMTCT care pathway.