Quality Improvement of HIV and RMNH Services

Aidsfonds (previously STOP AIDS NOW!) seeks to improve the quality of services related to HIV and reproductive, maternal, and newborn health (RMNH) for women and girls in Africa. We also aim to increase the uptake of good quality services by women and girls of reproductive age. Therefore, our work focuses on good clinical governance and community-driven accountability.

Good clinical governance

Worldwide, women living with HIV experience more stigma and rights violations in health care settings than HIV-negative women. They also experience most sexual and reproductive health and rights violations in RMNH settings. Health care services must be ethical and respect the human rights of patients. But they also need to be effective. Modelling shows that up to 55% of the cases of mother-to-child transmission of HIV that occur where prevention services are readily available may be due to stigma and discrimination.

Aidsfonds (previously STOP AIDS NOW!) provides knowledge and tools for systematically maintaining and upgrading the quality of HIV and RMNH services within existing health systems, in particular to improve clinical governance. Weak clinical governance is a key factor behind stigma and rights violations. When elements are lacking, or governance is poorly adapted to the clinical context, respect for the rights of patients and the quality of care are at risk. Research shows community-driven accountability improves clinical governance. Research also shows that community-driven accountability improves uptake of services. 

Guidance package

Aidsfonds (previously STOP AIDS NOW!) aims to improve clinical governance by providing a guidance package that health stewards (higher level health system policy makers, decision makers and overseers) and providers can use to improve the quality of HIV and RMNH services. This clinical governance guidance package will focus on providing recommendations and tools to improve protocols, standards and/or guidelines in relation to medical ethics issues. The guidance package will be developed on the basis of research on the quality of HIV and RMNH services at three health facilities in three health areas in Lilongwe District, Malawi.

Women living with HIV from support groups for the same three health areas will be trained to lead the research process. The project will capture that empowerment process in the form of a model, such that, at the end of the project, two tools will be available: one for improving clinical governance and another for developing community-driven accountability for quality HIV and RMNH services. These tools will be based on the experiences and lessons from the work in Malawi, but will be designed to contribute to HIV responses more broadly.