Quality Improvement Coordinator (Internship), Madiro
August 22, 2023
Ubuntu Village of Life is a medical clinic in the rural Mugamba Commune in Burundi, a small land-locked East African country. Ubuntu has become the heart of the community’s hope: providing local medical, ophthalmological and pharmaceutical care in addition to educational resources and local jobs.
But this is only the beginning for Ubuntu’s mission.
20 km away in the even more remote Kibezi, Ubuntu’s already building a satellite clinic with maternal and child health services. Across the Mugamba clinic there’s a huge pile of dirt — the construction zone for their future teaching hospital. 2 km away Ubtuntu’s planted hundreds of potato plants to support food security in the region.
There’s a lot of ambition in their plans. How can we support it?
This summer I worked with Madiro and Ubuntu Village of Life to establish Quality Improvement infrastructure so Ubuntu has the capacity to expand its operations while maintaining quality in their work.
What is Quality Improvement (QI)?
QI is the process of:
In the low-resource primary health context, some of the most crucial QI topics are infection prevention and control, maternal and child health, immunization coverage, malaria, HIV/AIDs and TB.
QI is a problem that will never fully be solved — there will always be ways to improve quality and react to new constraints. To do this effectively, health institutions need to have a QI team with a culture of continuous learning and adaptation.
With this QI foundation in place, we believe clinics like Ubuntu can better manage ambitious expansions and make the most of their resources.
The Ubuntu QI Project Framework
I worked with Madiro and UVL to define high standards for Quality Improvement (QI).
Using resources like the WHO Quality Toolkit and the Joint Commission international Primary Care Standards we created 5 core principles of QI:
To bring these principles to action, the clinical team decided to pilot a QI team with an emphasis on Infection Prevention and Control (IPC) focused on the first 3 principles. Then, we created a 4-phase roll-out to incorporate all 5 principles while expanding the QI capacity beyond IPC.
Field work for the pilot
After hundreds of hours with my head deep into the WHO’s QI recommendations, I headed on-ground to the clinic in Burundi to co-create with the local team.
The biggest emphasis for my fieldwork was getting to know the staff, their attitudes towards QI and IPC, and how the clinic standardizes its operations.
These activities really helped me understand the context to co-design QI at Ubuntu:
Towards the end of my 1-month field visit, we hosted the first official Quality Improvement Meeting (focused on IPC) where we discussed the data from these baselines!
There were a few key features for our first meeting:
It wasn’t a perfect meeting, but what’s important is we got the ball rolling! Afterwards I shared some suggestions for improving the flow for the next meeting. Remember: continuous learning and adaptation!
Key Insight: Loop Local Staff into the Vision 🔑
While much of my fieldwork was about data collection, interviews and supporting the QI team launch, arguably the most important part was getting all the staff’s buy-in.
I started by having many discussions trying to understand their feelings. Through them, I learned that QI is a pretty new term. When asked about quality improvement, they answered with the day-to-day activities they do that are high-quality. For example, hand washing, referring patients to the doctor, monitoring blood pressure, etc. Everyday, routine, short-term goals.
💡 Most staff have not been offered opportunities to think long-term. Their jobs are routine and without encouragement, they will stick to the short term.
To implement QI, we must look to the future. For example, it’s not effective in the short-term to organize and label all the clinic’s closets. That time could be spent serving patients! But, the accumulation of minutes or budget saved because of increased organization, in the long-run, is effective.
Empowering staff to contribute to QI was the highest ROI activity we did. By the end of the field work, people were energetic to be part of an expanding vision at Ubuntu! Here are some of the empowerment activities we did:
What’s Next for QI at Ubuntu?
We’ve created a 4-phase plan to roll out QI over the next 2 years. At a high level, here are the phases and their priorities:
Phase 1: Establishing the QI Team pilot with IPC
Phase 2: Increase the capacity of IPC-QI
During this phase, we hope that co-creating Standard Operating Procedures (SOPs) can be part of the annual goals.
Phase 3: Reach ‘Full’ IPC Capacity
Phase 4: Expanding QI
Let’s build infrastructure for the community!
Ultimately, the goal of this project was to create a customized Quality Improvement plan for Ubuntu Village of Life.
During my internship I got to see the impact Ubuntu’s had on the community in Burundi — from providing safe birthing places to giving people glasses to see — and I hope QI gives them the foundation to keep expanding their work!
About the author
Isabella is passionate about how technology can scale knowledge: distributing it to vulnerable healthcare and education systems. She's worked as product manager at The Knowledge Society, was the director at End Maternal Mortality, a misoprostol distribution project focused in Jigawa, Nigeria and has a personal blog with 120+ articles on the intersection of technology and the pursuit of improving human well-being. She's currently pursuing a BS in Chemistry at the University of North Carolina as a Morehead-Cain Scholar.
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