Health-care worker engagement in HIV-related quality improvement in Dar es Salaam, Tanzania

Objective: To assess health-care worker (HCW) awareness, interest and engagement in quality improvement (QI) in HIV care sites in Tanzania. Design: Cross-sectional survey distributed in May 2009. Setting: Sixteen urban HIV care sites in Dar es Salaam, Tanzania, 1 year after the introduction of a quality management program. Participants: Two hundred seventy-nine HCWs (direct care, clinical support staff and management). Main Outcome Measures: HCW perceptions of care delivered, rates of engagement, knowledge and interest in QI. HCWidentified barriers to and facilitators of the delivery of quality HIV care. Results: Two hundred seventy-nine (73%) of 382 HCWs responded to the survey. Most (86%) felt able to meet clients' needs. HCW-identified facilitators of quality included: teamwork (88%), staff communication (79%), positive work environment (75%) and trainings (84%). Perceived barriers included: problems in patients' lives (73%) and too few staff or too high patient volumes (52%). Many HCWs knew about specific QI activities (52%) or had been asked for input on QI (63%), but fewer (40.5%) had participated in activities and only 20.1% were currently QI team members. Managers were more likely to report QI involvement than direct care or clinical support staff (P<0.01). No difference in QI involvement was seen based on patient load or site type. Conclusions: HCWs can provide important insights into barriers and facilitators of providing quality care and can be effectively engaged in QI activities. HCW participation in efforts to improve services will ensure that HIV/AIDS quality of care is achieved and maintained as countries strive for universal antiretroviral access.