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

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  • Phillip Koni
  • Nathaniel Chishinga
  • Lameck Nyirenda
  • Prisca Kasonde
  • Richard Nsakanya
  • Michael Welsh

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.

Suggested Citation

  • Phillip Koni & Nathaniel Chishinga & Lameck Nyirenda & Prisca Kasonde & Richard Nsakanya & Michael Welsh, 2015. "Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-13, June.
    • Handle: RePEc:plo:pone00:0131084
    DOI: 10.1371/journal.pone.0131084
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    1. Gorrette Nalwadda & Nazarius M Tumwesigye & Elisabeth Faxelid & Josaphat Byamugisha & Florence Mirembe, 2011. "Quality of Care in Contraceptive Services Provided to Young People in Two Ugandan Districts: A Simulated Client Study," PLOS ONE, Public Library of Science, vol. 6(11), pages 1-8, November.
    2. Wilbroad Mutale & Peter Godfrey-Fausset & Margaret Tembo Mwanamwenge & Nkatya Kasese & Namwinga Chintu & Dina Balabanova & Neil Spicer & Helen Ayles, 2013. "Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
    3. LaPelle, N.R. & Zapka, J. & Ockene, J.K., 2006. "Sustainability of public health programs: The example of tobacco treatment services in Massachusetts," American Journal of Public Health, American Public Health Association, vol. 96(8), pages 1363-1369.
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