A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa

Int J Qual Health Care. 2013 Sep;25(4):373-80. doi: 10.1093/intqhc/mzt039. Epub 2013 May 24.


QUALITY PROBLEM AND ASSESSMENT: In South Africa (SA), non-governmental organizations (NGOs) have a major role in the provision of health services, but they often compete for funding and influence rather than collaborate. The National Department of Health (NDOH) sought to coordinate existing non-governmental organizations (NGOs) to optimize the prevention of mother-to-child HIV transmission (PMTCT) at scale.

Solution: We describe how a group of NGO and government partners were brought together to jointly develop the 'Accelerated Plan' (A-Plan) to improve PMTCT services at health-care facilities in SA. The A-Plan used four main principles of large-scale change to align the network of NGO partners and NDOH: setting targets and improving data, simplifying processes and facilitating local execution, building networks and enabling coordination.

Implementation: In the first 6 months of the project, six NGO partners were engaged and the program reached 161 facilities. The program spontaneously spread from five planned subdistricts to nine subdistricts and produced a package of tested interventions to assist in scale-up of the PMTCT program elsewhere.

Evaluation: Districts reported high levels of provider engagement in the initiative. In the 6-month project period, a total of 676 health-care workers and managers were trained in quality improvement methods and tools. Coverage of seven key processes in the PMTCT program was tracked on a monthly basis within each subdistrict.

Lessons learned: We found that a network model for the A-plan could successfully recruit key stakeholders into a strong partnership leading to rapid scale-up of a life-saving public health intervention.

Keywords: HIV; PMTCT; South Africa; implementation; scale-up.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Counseling
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / transmission*
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Mothers
  • Patient Care Management / organization & administration
  • Quality Improvement / organization & administration*
  • South Africa / epidemiology