Quality Improvement Project Monitoring (QI-PM)

Across the world, 11.8 million young people aged 15 to 24 years old are living with HIV (UNAIDS, 2022). Young people living with HIV (YPLHIV) have a right to high quality HIV services and Sexual and Reproductive Health and Rights (SRHR) services just like their counterparts who are not living with HIV. However, YPLHIV may face heightened challenges with accessing and receiving quality of care due to challenges such as stigma or transitions from pediatric to adult medical services. Whereas access refers to an individual’s ability to obtain health services, quality refers to whether the services offered and received are safe, effective, efficient, people-centered, timely, integrated, and equitable which are the World Health Organization’s domains for quality health services. Each year, gaps in quality of health care contribute to 5.7 to 8.4 million deaths in low and middle-income countries, representing 15% of overall deaths in LMICs and a loss of $1.4 to $1.6 trillion in productivity in these countries (National Academics of Sciences, Engineering, and Medicine, 2018). Presently, there are gaps in quality of SRHR services, including HIV services, for YLHIV.  >span class="NormalTextRun SCXW215942145 BCX0">monitor quality of SRHR services these YPLHIV are receiving, especially among services for young women in Sub-Saharan Africa who account for 82% of new HIV infections among young women (UNAIDS, 2021, p. 5). However, there is a lack of channels for youth to engage in monitoring the quality of youth-related SRHR services and to participate in quality improvement projects to improve these services. In other words, quality of youth SRHR services is being monitored and improved “for youth, without youth” instead of “by youth, with youth.” The time is now to give YPLHIV in Sub-Saharan Africa the tools they need to monitor the quality of SRHR services they receive and engage in work to continuously strengthen the quality of care they are offered.   

QI-PM is a web- and mobile-based digital application developed by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) on the Azure platform to track the progress and results of quality improvement (QI) projects over time. At health facilities in Sub-Saharan Africa, QI teams implement rapid projects and changes within their power to determine if these modest changes will improve the quality of services for recipients of care, including youth receiving HIV and SRHR services. Teams enter information about their project into the app, such as a description of the root cause of the gap in quality the project is working to address and a description of the change or mini intervention the team is testing. Each QI project monitors at least one key performance indicator; data points tracking the key performance indicator’s results are entered into the app weekly or monthly and visualized on an inbuilt line graph called a run chart to track performance overtime. Data across QI projects at a health facility and from all sites using QI-PM are visualized on a PowerBI data visualization dashboard used to analyze tested changes and identify promising practices across health facilities, districts, regions, countries, and programmatic areas (e.g., pediatrics, HIV prevention, cervical cancer). QI teams at health facilities in Sub-Saharan Africa use the app to monitor progress of QI projects at their site which are working to improve the quality of services offered to children, youth, mothers, and families receiving services at that site. District- and regional-level QI teams and advisors use the app to monitor QI activities across geographies in one centralized location.   

QI-PM presently serves QI teams at the health facility level which may include youth representatives, but with the support of MIT Solve we envision that the power of QI-PM could be put into the hands of YPLHIV themselves. By asking youth and YPLHIV what they want in QI-PM, modifying the app to make it more user friendly and inclusive of youth SRHR services, and creating youth-friendly user guides, we can make QI-PM more user friendly for youth and YPLHIV themselves. When YPLHIV access the QI-PM app from their smart phone or computer, we will literally place the power of QI into the palms of their hands so they can monitor QI projects at their facilities and be empowered with data and evidence to hold facilities accountable for offering them a continuously improving quality of care.  

Our team at EGPAF is uniquely positioned to deliver this solution to YPLHIV because of how close we are to youths’ communities themselves. EGPAF supports health facilities, SRHR programs, and HIV services for persons living with HIV in countries across Sub-Saharan Africa and has an office in many of these countries. EGPAF also is guided by its Committee of African Youth Advisors (CAYA), who are young people from across Sub-Saharan African countries who steer the Foundation’s focus on youth. In recent months, the QI team and CAYA have collaborated to build CAYA's capacity on QI so these youth leaders are now ready to enter the world of digitizing QI. To understand how to best make QI-PM user-friendly for youth, we will work with CAYA to hold a consultative meeting with youth to solicit recommendations about what features in QI-PM need to be adapted to be more youth friendly and inclusive of youth HIV and SRHR services. Changes youth recommend will directly inform modifications made to the mobile and web app. These youth will also be consulted as youth-friendly user guides are developed to accompany the app modifications. Once changes are made, user guides will be disseminated to CAYA members who can help train other youth on how to access QI-PM and engage in QI at their health facilities to hold EGPAF accountable for the quality of services offered to youth. EGPAF is uniquely positioned to engage YLHIV and youth in improving the quality of care for youth by youth at the health facilities it supports.  

QI-PM has been used by 400+ health facilities across 9 Sub-Saharan African countries.