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A report on using QI strategies to improve HIV care explains how the Breakthrough Series model was adapted to support community health workers.
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Community-Based Adaptations of the IHI Breakthrough Series Model

By Pierre Barker | Tuesday, July 21, 2015

A new article co-authored by Dr. Pierre Barker, IHI Senior Vice President, provides examples of how the IHI Breakthrough Series model was adapted in four community-based quality-improvement projects in South Africa, Malawi, and Mozambique to support community volunteer health workers in improving HIV care.


The IHI Breakthrough Series model typically brings together clinical and leadership teams from health facilities, sometimes including community members. A report published this month in an AIDS journal supplement on the use of quality improvement strategies to improve HIV care, provides four examples of how the Breakthrough Series model was adapted to support community volunteer health workers to improve care deep in the community. In their study, authors describe how they successfully experimented with the Breakthrough Series model, using community health workers as key change agents in improving delivery of care and retention in care.

In a test of the applicability of the Breakthrough Series model outside care facilities in three different countries, community workers with limited literacy and numeracy skills were able to collect and use data to identify gaps and track progress. In work led by Edward Moses from MaiKhanda in Malawi, village volunteers were assigned responsibility for tracking pregnancies and ensuring that mothers and newborns attended care facilities before, during, and after delivery. In a project supported by USAID ASSIST in Mozambique, the existing village health committee served as the community-based improvement team, and coordinated the village’s health-improvement activities around postnatal prevention of mother-to-child transmission of HIV in breastfeeding mothers. In South Africa, IHI’s 20,000+ and Centre for Rural Health partners supported community volunteers to promote safe care practices for newborns and early referrals of sick babies. And in Cape Town, South Africa, IHI faculty member Michele Youngleson used the Breakthrough Series model to scale up an innovative Medecins Sans Frontiers prototype of community-based HIV care “clubs” for cohorts of patients on long-term treatment [see photo].

A community volunteer meets with a cohort of AIDS patients each month to facilitate a peer-support meeting to promote adherence to medications and relieve burden of care from the clinic-based system.

Mostly, the adaptation of the Breakthrough Series model for use in community settings was straightforward. However, QI processes needed to be adapted to the literacy and numeracy skills of the providers, and teams required additional support. For data records, collection and presentation of data required simplified tools. In two projects, teams tracked numerators and denominators in hand-drawn tables and avoided using run charts. Overall, the Breakthrough Series model was successfully adapted for use in communities outside traditional clinical facility settings.

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