Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi
Abstract Background Coverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality im...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-020-05538-2 |
| _version_ | 1819330761473392640 |
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| author | Anne Laterra Tegan Callahan Thumbiko Msiska Godfrey Woelk Pari Chowdhary Sara Gullo Patience Mgoli Mwale Surbhi Modi Felluna Chauwa Dumbani Kayira Thokozani Kalua Etobssie Wako |
| author_facet | Anne Laterra Tegan Callahan Thumbiko Msiska Godfrey Woelk Pari Chowdhary Sara Gullo Patience Mgoli Mwale Surbhi Modi Felluna Chauwa Dumbani Kayira Thokozani Kalua Etobssie Wako |
| author_sort | Anne Laterra |
| collection | DOAJ |
| description | Abstract Background Coverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality improvement process could address persistent gaps, we adapted a social accountability approach, CARE’s Community Score Card© (CSC), to the PMTCT context. The CSC process generates perception-based score cards and facilitates regular quality improvement dialogues between service users and service providers. Methods Fifteen indicators were generated by PMTCT service users and providers as part of the CSC process. These indicators were scored by each population during three sequential cycles of the CSC process which culminates in a sharing of scores in a collective meeting followed by action planning. We aggregated these scores across facilities and analyzed the differences in first and last scorings to understand perceived improvements over the course of the project (z-test comparing the significance of two proportions; one-tailed p-value ≤ .05). Data were collected over 12 months from September 2017 to August 2018. Results Fourteen of the fifteen indicators improved over the course of this project, with eight showing statistically significant improvement. Out of the indicators that showed statistically significant improvement, the majority fell within the control of local communities, local health facilities, or service providers (7 out of 8) and were related to patient or user experience and support from families and community members (6 out of 8). From first to last cycle, scores from service users’ and service providers’ perspectives converged. At the first scoring cycle, four indicators exhibited statistically significant differences (p-value ≤ .05) between service users and service providers. At the final cycle there were no statistically significant differences between the scores of these two groups. Conclusions By creating an opportunity for mothers living with HIV, health service providers, communities, and local government officials to jointly identify issues and implement solutions, the CSC contributed to improvements in the perceived quality of PMTCT services. The success of this model highlights the feasibility and importance of involving people living with HIV in quality improvement and assurance efforts. Trial registration Trial registration: ClincalTrials.gov NCT04372667 retrospectively registered on May 1st 2020. |
| first_indexed | 2024-12-24T14:03:40Z |
| format | Article |
| id | doaj.art-5c0af93eb0b24beeaba64959c5799132 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-24T14:03:40Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-5c0af93eb0b24beeaba64959c57991322022-12-21T16:52:24ZengBMCBMC Health Services Research1472-69632020-07-0120111410.1186/s12913-020-05538-2Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in MalawiAnne Laterra0Tegan Callahan1Thumbiko Msiska2Godfrey Woelk3Pari Chowdhary4Sara Gullo5Patience Mgoli Mwale6Surbhi Modi7Felluna Chauwa8Dumbani Kayira9Thokozani Kalua10Etobssie Wako11CARE USACenters for Disease Control and PreventionCARE MalawiElizabeth Glaser Pediatric AIDS FoundationCARE USAIndependent consultantCARE MalawiCenters for Disease Control and PreventionElizabeth Glaser Pediatric AIDS FoundationCenters for Disease Control and PreventionMinistry of HealthCARE USAAbstract Background Coverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality improvement process could address persistent gaps, we adapted a social accountability approach, CARE’s Community Score Card© (CSC), to the PMTCT context. The CSC process generates perception-based score cards and facilitates regular quality improvement dialogues between service users and service providers. Methods Fifteen indicators were generated by PMTCT service users and providers as part of the CSC process. These indicators were scored by each population during three sequential cycles of the CSC process which culminates in a sharing of scores in a collective meeting followed by action planning. We aggregated these scores across facilities and analyzed the differences in first and last scorings to understand perceived improvements over the course of the project (z-test comparing the significance of two proportions; one-tailed p-value ≤ .05). Data were collected over 12 months from September 2017 to August 2018. Results Fourteen of the fifteen indicators improved over the course of this project, with eight showing statistically significant improvement. Out of the indicators that showed statistically significant improvement, the majority fell within the control of local communities, local health facilities, or service providers (7 out of 8) and were related to patient or user experience and support from families and community members (6 out of 8). From first to last cycle, scores from service users’ and service providers’ perspectives converged. At the first scoring cycle, four indicators exhibited statistically significant differences (p-value ≤ .05) between service users and service providers. At the final cycle there were no statistically significant differences between the scores of these two groups. Conclusions By creating an opportunity for mothers living with HIV, health service providers, communities, and local government officials to jointly identify issues and implement solutions, the CSC contributed to improvements in the perceived quality of PMTCT services. The success of this model highlights the feasibility and importance of involving people living with HIV in quality improvement and assurance efforts. Trial registration Trial registration: ClincalTrials.gov NCT04372667 retrospectively registered on May 1st 2020.http://link.springer.com/article/10.1186/s12913-020-05538-2PMTCTHIVQuality improvementSocial accountabilityParticipationVoice |
| spellingShingle | Anne Laterra Tegan Callahan Thumbiko Msiska Godfrey Woelk Pari Chowdhary Sara Gullo Patience Mgoli Mwale Surbhi Modi Felluna Chauwa Dumbani Kayira Thokozani Kalua Etobssie Wako Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi BMC Health Services Research PMTCT HIV Quality improvement Social accountability Participation Voice |
| title | Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi |
| title_full | Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi |
| title_fullStr | Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi |
| title_full_unstemmed | Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi |
| title_short | Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi |
| title_sort | bringing women s voices to pmtct care adapting care s community score card c to engage women living with hiv to build quality health systems in malawi |
| topic | PMTCT HIV Quality improvement Social accountability Participation Voice |
| url | http://link.springer.com/article/10.1186/s12913-020-05538-2 |
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