Implementation of quality improvement for community-based health services: what worked, what didn’t, and why? A case study in Ethiopia

Background: Recently, there has been a growing interest in quality improvement (QI) interventions to enhance the health care services provision. However, applying QI interventions to community-based health services (CBHS) is still a limited practice. Strengthening Ethiopia’s Urban Health Program (SEUHP), implemented by John Snow, Inc., used QI principles to address certain challenges in the implementation of the urban health extension program (UHEP). QI activities aimed to improve referral systems between the UHEP and health centers (HCs), strengthen the defaulter tracing system, and enhance linkages and integration between facility-based primary health services and community-based extension services. Aim: This case study reviews the implementation and documents lessons learned from the SEUHP QI intervention. Method: Assessment and multiple case study design to review the implementation and document lessons learned. The study reviews multiple data sources and qualitatively analyzes the experience of QI teams (QIT) in different regions in Ethiopia. Findings: The functionality of the QIT varies across the regions. Where QI interventions function, demand for specific health services increased and QITs met targeted improvement objectives. The linkage and integration between the community-based UHEP extension services and facility health services improved as the result of QI intervention. Conclusion: This case study provides evidence that, despite challenges, QI interventions can be an important tool for facilitating health services. Functional QITs helped motivate Urban Health Extension Professionals (UHE-ps) to effectively execute their job. The QIT’s commitment, the regularity of QIT meetings, and the engagement of all staff and community groups are key factors in the successful implementation of QI initiatives that resulted in improved quality of service provision. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):54-61] Keywords: Quality Improvement, Community, Urban Health, Ethiopi

A community based study on knowledge, attitude and practice (KAP) on HIV/AIDS in Gambella town, Western Ethiopia

Background: HIV/AIDS is the major public health problem in our country. Studies need to be conducted to assess the behavioral risk factors of its transmission and prevention. Objectives: To assess knowledge, attitude and practice of HIV/AIDS in the study population. Methods: Community based cross-sectional study was done to assess the knowledge, attitude and practice on HIV/AIDS among individuals aged 15 years and above in Gambella town in November, 2000. Structured questionnaire was used to collect data. Results: A total of 359 individuals were interviewed among whom 53.8% were males. Fifty-five percent of them were between 20 and 30 years of age. Majority of the study population were government employee. Sixty six percent were married while 25% were single. Oromos (32.9%), Agnuaks (21.4%), Amharas (16.7%) and Nuers (12.5%) were the major ethnic groups in the study population. About ninety six percent of the interviewed population reported to have heard about HIV/AIDS for whom the main source of information was the mass media (82.8%). The majority reported unprotected sex (79.7%) and unsafe blood transfusion (64.2%) as common ways of HIV transmission. About eighty six percent and 80% agreed on screening before marriage and voluntary testing respectively. Eighty six percent practiced sex at a mean age of first sexual contact of 16.6 and 18.4 years of females and males, respectively. Among those who had sexual contact with nonregular partner in the last one year, 39.6% did not use condoms. Males had higher rate of STDs as compared to females (21.1% and 12.2% respectively). Males were also observed to have significantly higher frequencies of sexual contact with non-regular partner in the last one year (p=0.00). Conclusions: The findings of the study showed that sexual practice often begun as early as eleven years of age with the mean of age 16 and 18 years for females and males, respectively. The respondents were observed to have adequate knowledge although risky behavior is prevailing. Therefore, we recommend that health education should target elementary school children and those children who are not at school as early as the age of ten years. The knowledge of mother to child transmission in the region is limited. Hence, emphasis also needs to be given to improve the knowledge on mother to child transmission of HIV. Information dissemination should also be designed in such a way to bring about behavioral change. Regular assessment on the impact of the intervention should also be done. Ethiop. J.Health Dev.2003;17(3):205-21