Quality management is a cornerstone of sustainability. By maximizing the effective use of increasingly scarce resourcesfor health, USAID aims to establish achievable standards by giving district managers and health care providers the problem-solving tools they need to analyze barriers to quality care and to identify feasible actions to overcome them. Through the Quality Assurance Project, USAID has achieved measurable results in improving the quality of health care in South Africa.

In South Africa’s Mpumalanga Province, the EQUITY  and Quality Assurance (QA) Projects are supporting quality improvement activities in three pilot health wards to reduce neonatal mortality and to strengthen TB case detection and treatment. Through a series of workshops, the QA team first trained core groups in each of 16 sub-districts in basic QA methodologies. Baseline assessments identified the most pressing needs at each facility, while quality teams were formed in all the districts. The QAP approach aims not only institutionalise quality assurance at health facilities, but most importantly, to build the capacity of health staff to monitor and continue progress themselves.

In today’s world, sex and youth can be a deadly combination. This fact is particularly true in South Africa, where 30% of the population is HIV positive and sexual activity starts in the mid-teens for the majority of youth. Recognizing that public health facilities are failing to provide services to meet adolescents’ needs, in 2000 the National Department of Health, the Reproductive Health Research Unit, and provincial Departments of Health established the National Adolescent Friendly Clinic Initiative (NAFCI), to improve the accessibility and availability of services for youth, particularly for reproductive health and HIV prevention. Ten adolescent reproductive health standards have been implemented in 10 pilot clinics through a facilitative process involving routine visits by quality facilitators. NAFCI’s ultimate goal is to refine a process for improving adolescent health care in clinics throughout the country, building the capacity and commitment of health care workers to provide quality adolescent health services.

USAID and the Quality Assurance Project also support the non-profit Council for Health Services Accreditation of Southern Africa (COHSASA), which was established in 1995 to assist disadvantaged health care facilities to meet agreed minimal professional standards. COHSASA has developed and refined over 6000 standard criteria for evaluating hospitals. Following an initial self-assessment and validation survey, facilitators assist hospitals to achieve accreditation within about 18 months through regular visits. In 1998, KwaZulu-Natal Province, one of the country’s poorest, contracted with COHSASA to establish an accreditation program. The QA Project’s operations research study has documented that all hospitals participating in the program have substantially improved their compliance with accreditation standards. Average compliance with standards increased from 48 percent to 78 percent (a 63 percent increase). 

For more information on the Quality Assurance Project, please visit: www.urc-chs.com.