Tanzania
Since 2004, the University of Maryland, Baltimore has implemented US government- and WHO-funded HIV and tuberculosis programs in 21 regions and 97 districts of Tanzania, partnering with more than 20 international, local, and faith-based organizations. Ciheb Tanzania is currently comprised of a team of more than 50 clinical and supporting staff.
Ciheb Tanzania has been a leader in providing continuous quality improvement (CQI) technical assistance. CQI involves routine internal and external assessments of the healthcare performance, with action plans to address gaps in delivery. To allow CQI to be measured in an accurate and timely manner, Ciheb pioneered several electronic reporting platforms. The mobile-based applications complement a web dashboard that allows users to track projects and share their success stories.
Projects
Afya Kamilifu Project. Afya Kamilifu (“complete health” in Swahili) is a comprehensive HIV care and treatment program implemented in partnership with Amref Health Africa in the Zanzibar Islands, Tanga, and Simiyu regions. As a subgrantee, Ciheb supports TB/HIV and TB clinics and pediatric and adolescent HIV care. It also leads the project’s overall CQI, cutting across all departments and thematic areas.
Through district-based mentorships, data-driven site visits by project staff, and by building the technical capacity of facility healthcare workers, Ciheb has improved performance across numerous key indicators. For example, isoniazid preventative therapy completion rates improved from 32% to above 95%, viral load suppression in children and adolescents improved from 54% to beyond 97%, and the proportion of children in an optimized antiretroviral regimen has remarkably improved (99% of all children and adolescents are in optimized regimens). Also, all the children have attended their appointment (recent retention). Also, Ciheb has initiated CQI projects across all key indicators across CDC tier I to III facilities.
MDH Support. UMB team continue to work on the previously developed patient-level-data CQI root cause analysis dashboard (DFQI). The work focused on improving performance on CQI indicators by helping the technical team to identify site-level issues and missed opportunities by HCPs. We have added several queries from the original indicators. The updates help in identifying missed opportunities in CD4 uptake and CrAg test documentation for all clients with CD4<200 in priority groups. These groups are TX New>5 Years, Clients with persistent High VL, TXRTT, and newly changed Stage 3 and 4 Clients. This DFQI has now been incorporated/embedded into CARE. We have also oriented MDH DREAMS team staff on developing geospatial maps and using the maps to identify areas with uncovered interventions. The maps are for AGYW from 15-24 who are out of school. These Maps are intended to assist the team to monitor implementation, evaluate the impacts of interventions and respond to some extra key questions as indicated in the M&E framework of the DREAMS program. Maps on AGYW distributions based on 2022 census data at district & ward level have been submitted to MDH. Maps showing the impact of program interventions, distribution as per teen pregnancies, and out of school are in progress.
Polio Lab Sample Transport Program. This is a one-year program funded by the Bill and Melinda Gates Foundation through Village Reach. The goal of this program is to help stop transmission of wild or vaccine-derived poliovirus in non-endemic countries and prevent outbreaks by increasing the speed of detection of the virus and precision of the surveillance system, as outlined in the Global Polio Eradication Initiative (GPEI) strategy 2022-2026. The program in collaboration with Ministry of Health, Immunization and Vaccination Unit (IVD) works to improve timeliness of polio sample transport and Vaccine Preventable Disease surveillance through capacity building at Regional & Councils, facility and community levels, development and dissemination of guidelines, job aids, and SOPs, support data utilization at National and lower level and piloting a more sustainable sample referral system through integration of the polio sample transport system with other existing disease systems.
Continuous Quality Improvement
Tanzania
Implementing CQI programs in Tanzania
Previous Projects
Reaching, Engaging, and Acting for Health (REACH)
Reaching, Engaging, and Acting for Health (REACH). The REACH Project was a PEPFAR-funded project working in 10 regions of Tanzania. This national-level technical assistance program focused on improving uptake of data and evidence for faster HIV epidemic control achievement. REACH supported the Government of Tanzania and CDC-funded local clinical implementing partners in minimizing systemic and structural barriers that impede the development of quality HIV/AIDS services.
REACH supported approximately 120 health facilities and trained and mentored more than 400 healthcare providers on CQI methodologies with the aim of improving PEPFAR clinical cascade indicators. A digital CQI platform developed under the REACH project for reporting and supporting routine monitoring of program performance scaled up to more PEPFAR implementing partners. The platform was being used in 200 facilities and has more than 650 quality improvement projects targeting different areas of HIV/AIDS service delivery.
Through the REACH project, Ciheb Tanzania developed the platforms for which it is widely known that support real-time data quality checks, SMS weekly reporting, CQI reporting, and granular data analysis through the Data Analytics Companion (DAC), a powerful tool developed by Ciheb Tanzania that performs in-depth patient-level data analytics.
Given the efficiency and user-friendliness of Ciheb Tanzania's tools, the Government of Tanzania, through its National AIDS Control Program, adopted the digital CQI platform tool to support its Quality Improvement Collaborative initiative. The CQI digital platform has also been adopted by other Ciheb country offices in Zambia, Kenya, Botswana, and Rwanda.
REACH was national ECHO coordination role and supports HIV clinics through ECHO.
In addition, Ciheb Tanzania developed the following technologies to support implementation:
- An Android application (IQSMS) for daily and weekly monitoring of HIV and viral load testing indicators.
- Real-time data quality assurance to inform data gaps in government data reporting tools such as DHIS2.
- Quality management of laboratory proficient testing for reporting laboratory proficiency testing data.
- An index contact tracking tool for the electronic tracking of sexual contacts of newly identified HIV-positive clients.
- A monthly reporting tool (Monthly Portal) that aggregates data reported by all health facilities and supports data visualization at the regional, district, and facility levels, providing opportunities for performance comparison across facilities and regions and enabling better planning and health resources rationalization for the program and by facilities and regional health management teams.
COVID-19
COVID-19. In 2020, and in efforts to minimize the spread of COVID-19, CDC Tanzania and the implementing partners scaled down physical site visits substantially. To ensure HIV service delivery was not interrupted, Ciheb Tanzania demonstrated an effective way of remote support for health facilities using various online platforms, such as Zoom and ECHO. Ciheb was able to continue supporting facilities in data analysis, identification of performance gaps, and initiating quality improvement activities.
The DAC tool was effective in supporting remote data analysis. Quality improvement projects were initiated for areas that were not performing well and documented in the digital CQI platform. The use of the digital CQI platform increased from approximately 300 projects in March 2020 to more than 650 projects by July 2020. The Ciheb team held multiple Zoom calls with improvement teams from all the supported regions where they would present their ongoing activities directly from the platform. These calls were attended by implementing partners and members of the regional and council health management teams.