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Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia.

Koni P, Chishinga N, Nyirenda L, Kasonde P, Nsakanya R, Welsh M - PLoS ONE (2015)

Bottom Line: Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata. 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate.The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings.Human resources management domain was found to be an important factor associated with district graduation.

View Article: PubMed Central - PubMed

Affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.

ABSTRACT

Introduction: The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation.

Methods: Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata.

Results: 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20-1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24-1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings.

Conclusions: QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation.

No MeSH data available.


Related in: MedlinePlus

Graduation scores by province in graduated and non-graduated districts.Central OR 1.61 (95%CI: 1.31–1.97), P<0.001; Copperbelt OR 1.12 (95%CI: 0.90–1.39), P = 0.279; Luapula OR 0.87 (95%CI (0.66–1.15), P = 0.322; Northern OR 1.33 (95%CI (1.00–1.78), P = 0.052; North-western OR 1.45 (95%CI (1.07–1.96), P = 0.015.
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pone.0131084.g003: Graduation scores by province in graduated and non-graduated districts.Central OR 1.61 (95%CI: 1.31–1.97), P<0.001; Copperbelt OR 1.12 (95%CI: 0.90–1.39), P = 0.279; Luapula OR 0.87 (95%CI (0.66–1.15), P = 0.322; Northern OR 1.33 (95%CI (1.00–1.78), P = 0.052; North-western OR 1.45 (95%CI (1.07–1.96), P = 0.015.

Mentions: The overall mean percentage score stratified by province was 90% and above in both graduated and non-graduated districts in four of the five provinces; the overall mean percentage score in Central province for districts that did not graduate was 88% (Fig 3). The overall percentage score was statistically significantly higher in graduated than non-graduated districts in Central province (OR = 1.6, 95% CI: 1.31–1.97, P <0.001) and North Western province (OR = 1.45, 95%CI: 1.07–1.96, P = 0.015).There was no statistically significant difference between graduated and non-graduated districts in the other provinces. In both Central and North Western provinces lack of human resource management contributed to this overall difference observed in graduated versus non-graduated districts; in Central province the mean percentage score for human resource management domain was 86.4% in graduated districts and 38.7% in non-graduated districts (OR = 10.03, 95%CI: 5.29–16.98, P <0.001), while in North-western province it was 91.8% in graduated districts and 61.2% in non-graduated districts (OR = 7.12, 95%CI: 3.17–16.00, P <0.001).


Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia.

Koni P, Chishinga N, Nyirenda L, Kasonde P, Nsakanya R, Welsh M - PLoS ONE (2015)

Graduation scores by province in graduated and non-graduated districts.Central OR 1.61 (95%CI: 1.31–1.97), P<0.001; Copperbelt OR 1.12 (95%CI: 0.90–1.39), P = 0.279; Luapula OR 0.87 (95%CI (0.66–1.15), P = 0.322; Northern OR 1.33 (95%CI (1.00–1.78), P = 0.052; North-western OR 1.45 (95%CI (1.07–1.96), P = 0.015.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4476711&req=5

pone.0131084.g003: Graduation scores by province in graduated and non-graduated districts.Central OR 1.61 (95%CI: 1.31–1.97), P<0.001; Copperbelt OR 1.12 (95%CI: 0.90–1.39), P = 0.279; Luapula OR 0.87 (95%CI (0.66–1.15), P = 0.322; Northern OR 1.33 (95%CI (1.00–1.78), P = 0.052; North-western OR 1.45 (95%CI (1.07–1.96), P = 0.015.
Mentions: The overall mean percentage score stratified by province was 90% and above in both graduated and non-graduated districts in four of the five provinces; the overall mean percentage score in Central province for districts that did not graduate was 88% (Fig 3). The overall percentage score was statistically significantly higher in graduated than non-graduated districts in Central province (OR = 1.6, 95% CI: 1.31–1.97, P <0.001) and North Western province (OR = 1.45, 95%CI: 1.07–1.96, P = 0.015).There was no statistically significant difference between graduated and non-graduated districts in the other provinces. In both Central and North Western provinces lack of human resource management contributed to this overall difference observed in graduated versus non-graduated districts; in Central province the mean percentage score for human resource management domain was 86.4% in graduated districts and 38.7% in non-graduated districts (OR = 10.03, 95%CI: 5.29–16.98, P <0.001), while in North-western province it was 91.8% in graduated districts and 61.2% in non-graduated districts (OR = 7.12, 95%CI: 3.17–16.00, P <0.001).

Bottom Line: Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata. 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate.The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings.Human resources management domain was found to be an important factor associated with district graduation.

View Article: PubMed Central - PubMed

Affiliation: FHI 360, PO Box 320303, Lusaka, Zambia.

ABSTRACT

Introduction: The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation.

Methods: Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata.

Results: 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20-1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24-1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29-7.86) and in both rural and urban settings.

Conclusions: QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation.

No MeSH data available.


Related in: MedlinePlus