Zambia has made important progress in halting and beginning to reverse the effects of its HIV epidemic, but data show the work that still needs to be done to reach the UNAIDS goals of 95-95-95 within 10 years. In collaboration with CDC, FHI 360 and its partners—the Institute for Health Measurement and Project ECHO—will provide technical assistance to build the capacity of personnel delivering HIV/AIDS services throughout Zambia’s health system in Eastern, Lusaka, Southern, and Western Provinces. The project’s purpose is to help Zambia reach HIV/TB-related targets towards epidemic control through systematic and sustainable capacity building at provincial, district, and levels. The technical assistance package will enable the supply (managers, providers) and demand (recipients) sides of HIV/TB services to intensely and collaboratively engage in producing quality services and performance outcomes.
The proposed framework for technical assistance is the Total Quality Leadership and Accountability (TQLA©) model, which FHI 360 developed in previous PEPFAR-funded work in Zambia and has since extended elsewhere. TQLA© is an innovative and adaptive management approach to drive performance, strengthen capacity of implementers at all levels to be more accountable, use data to strategically prioritize local solutions to address performance challenges, and improve outcomes at lower cost. Importantly, TQLA© sets the foundation for sustainable practices that will enable the Ministry of Health (MOH) to achieve specified outcomes by continuously monitoring developments with real-time data, facilitating daily communication and decision making, and selecting evidence-informed practices.
FHI 360 proposes to initiate technical assistance services through rapid assessments to identify organizational capacity and gaps, then work with CDC and MOH personnel to prioritize areas for capacity building. Technical assistance will be provided through multiple methods: training, continuous education, interactive video sessions, mentorship, data-driven site visits, technology platforms, coordination meetings, and systems development. Evaluation and performance monitoring are integral practices in our approach. Indicator data will be collected and analyzed to track accomplishments and facilitate program improvement. Metrics will be assessed in Situation Room meetings — which are short, frequent meetings held at provincial, district, and facility locations — as MOH managers and experts review real-time data, provide immediate feedback to staff, and make evidence-based decisions on corrective measures or replication of successful strategies.
The proposed technical assistance activities will increase MOH capacity for provision, oversight, and coordination of quality services; improve MOH coverage and achievement of service delivery targets; and improve MOH data management and data quality systems. In the intermediate term, technical assistance will further deepen the quality of services, oversight, and coordination resulting in improved patient outcomes. The outcomes include improved client experience, retention on ART, and increased efficiencies in workforce, resource management, and unit cost of HIV care and treatment—thereby achieving more with less, a precursor for HIV program sustainability. These short term and intermediate outcomes will culminate in the long-term outcome: increased provincial-level performance toward achieving sustainable epidemic control.