Effect of Quality Improvement Approaches on Prevention of Mother to Child Transmission Services Coverage in Nairobi County
Abstract
Background: Improving the quality of healthcare is a growing international concern as it ensures
that the healthcare system functions efficiently. Quality improvement in the HIV field focuses on
achieving essential health outcomes, including patient retention, increasing viral load suppression,
and improving overall health outcomes of people living with HIV. Quality Improvement (QI)
approaches form part of the global strategies recommended by WHO to improve prevention of
mother to child transmission (PMTCT) coverage and to achieve virtual elimination of mother to
child transmission (MTCT). Nairobi County is implementing QI approaches using the Kenya
Quality Model for Health (KQMH) framework. The implementation of QI began in January 2016,
and since then, the facilities have formed work improvement teams (WITs) that work to improve
the quality in the facilities.
Study objective: This study sought to evaluate the effect of quality improvement approaches on
PMTCT coverage in Nairobi County.
Methodology: This quasi-experimental study applied a mixed-method research methodology.
Purposive sampling determined the four study facilities. The participants were women attending
the PMTCT clinic at the selected facilities, identified through a purposive sampling process. DHIS
reports and facility registers provided the necessary quantitative data, while Focus Group
Discussions (FGDs) and Key informant interviews (KIIs) provided qualitative data. Quantitative
data showing service delivery uptake over time provided a trend on the performance of the key
indicators under study. This data analyzed using an interrupted time series approach as well as by
using descriptive statistics showed trends over time. Qualitative data assessed clients’ experiences
while accessing PMTCT services, providing key insights from the clients’ perspective. The
researcher used content analysis to analyze this data.
Results: The study found out that quality improvement is an integral part of PMTCT service
delivery. Through the FGDs, the PMTCT services provided generally satisfy the clients’ needs,
and that the clients have a significant role in quality improvement. The HCWs can implement QI
approaches as long as they have the facility management's support and leadership.
Conclusion and recommendation: The study found out that quality improvement in PMTCT
relies heavily on the systems being in place and on teamwork between the HCWs and clients as
they access treatment services at the health facilities. The study recommends that the amplification
of quality improvement approaches covers other service delivery areas and that the facility
management is at the forefront in the implementation and monitoring of the QI approaches.
Publisher
UON
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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