WHO highlights the need for a “quality revolution” and scaling up quality management efforts within HIV programmes.
This call to action is particularly important in the context of universal health coverage for all, which specifies that health services be “of sufficient quality to be effective” (Sustainable Development Goal, Target 3.8) and be informed by scientific evidence .
The delivery of high-quality HIV care and treatment services can facilitate a marked reduction of new infections; decrease HIV-related morbidity and mortality; and bring us ever closer to meeting global HIV targets for the elimination of HIV and AIDS.
But what does “quality” really mean?
In the brief, WHO consolidates existing guidance on what constitutes quality HIV programmes in low- and middle-income countries from the perspective of the policy-maker, programme manager and implementing partner.
In the context of HIV, as with all health issues, a people-centred approach is paramount to achieving quality services and outcomes. The needs of the patient should be prioritized, empowering people to take control of their own health.
The publication documents case studies of quality management approaches from national programmes. In Mozambique, for example, a quality management programme resulted in an improvement of 9 percentage points for early infant diagnosis (79% to 88%) and 5 percentage points for early retention (51% to 56%), from 2016 to 2019. In Zimbabwe, quality management increased same-day antiretroviral treatment (ART) uptake from 54% in February 2017 to 77% in August 2018. Moreover, 6-month viral load coverage of people newly initiating ART rose from 16% to over 40% during the same period.
Despite encouraging case studies, current momentum towards quality health service delivery remains slow. “A ‘quality revolution’ requires accelerated awareness and engagement by ministries of health and stakeholders, communities and recipients of care, combined with new or strengthened partnerships with local organizations and donor agencies,” said Dr Satvinder Singh, Medical Officer on Tuberculosis/HIV and Quality of Care at WHO.
“Efforts to prioritize a culture of quality of care need to be reinforced,” she said. “Local systems and infrastructure require investment, and information systems for programme data collection need updating.”
In providing examples of how national programmes can ensure excellence in HIV services through quality planning strategies, WHO calls for quality management to be included at every level – from national HIV policies, through to the establishment of quality assurance and improvement systems in clinics.
Several models of quality improvement are listed including “Six Sigma”, “lean” and others. Each leverages the “plan-do-study-act” cycle method, which is used to continually improve health system performance and is outlined in the document.
Reducing stigma and discrimination against people living with or affected by HIV, including within the health system, is emphasised.
Service delivery should focus on ensuring a positive patient experience, and more broadly, on promoting a health care delivery culture that prides itself on providing the highest quality of care possible.
Quality services should be safe, acceptable and appropriate to the patient, and health system resources should be easily accessible and efficiently used. Capacity to implement the necessary changes across the health care system to foster a culture of quality must be enabled for all HIV programmes to deliver quality care.
In its latest technical brief, WHO calls for a quality revolution and seeks to refocus and energize HIV programmes in their efforts to ensure the delivery of high-quality HIV services for all people living with HIV.