Implementation of a Quality Improvement Approach for Malaria Service Delivery in Zambezia Province, Mozambique

Baltazar Candrinho, Armindo Tiago, Custodio Cruz, Mercino Ombe, Katherine Wolf, Maria da Luz Vaz, Connie Lee and Rosalia Mutemba are sharing their work during a scientific session on enhancing quality of care for malaria services in Mozambique at the 66th Annual Meeting of the American Society of Tropical Medicine 66th Annual Meeting on 6 November 2017. A summary of their talk follows:

In Mozambique, malaria in pregnancy (MIP) is one of the leading causes of maternal and newborn morbidity and mortality. Malaria also accounts for over 40% of deaths in children less than five years old. With provincial and facility-level commitment, a simple and comprehensive quality improvement (QI) system has been established in 10 of 16 districts in Zambezia Province.

Since 2016, the Mozambique Ministry of Health (MOH) and Zambezia Provincial Health Directorate, in collaboration with partners, have implemented a malaria QI effort based on the Standards-Based Management and Recognition (SBM-R) approach. A standards-based approach to improving quality of malaria care engages both management and service providers to work together to assess the current performance, address gaps to ensure that all patients receive a minimum (standardized / evidence-based) package of care, and ultimately improve patient outcomes and facility performance.

Thirty-one performance standards in five content areas (MIP, Case Management, Laboratory, Pharmacy, and Management of Human Resources and Malaria Commodities) were developed and adopted by the MOH in 2016. With support from partners, 40 health workers, including managers, clinicians and lab technicians, received training on SBM-R, and facility QI teams were established.

These teams use checklists based on standards to conduct quarterly assessments that identify performance gaps, and then develop action plans to address areas of improvement. The MOH antenatal care and child health registers also contain information on coverage of key malaria interventions, including IPTp, and malaria diagnosis and treatment during pregnancy and for children under five with fever.

Average attainment of standards at baseline in 20 health facilities was 30%, and is expected to improve as implementation progresses with quarterly application of the checklist (data will be available before November). Improvements in key malaria indicators for pregnant women and children under five years old are expected as the percentage of standards attained increases.

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