The Zambia quality assurance program: Successes and challenges

Objectives. The objectives of the evaluation were to review the performance of the Zambia Quality Assurance Program (ZQAP) and provide recommendations to help design its next phase. Design and methods. Topics for evaluation were identified from a systems analysis of what an 'ideal' quality assurance (QA) program might look like. The evaluation team was made up of six experts who developed questionnaires to guide the interviews and related scoring tools. The evaluation team visited 24 health facilities in nine districts, representing all four regions of Zambia, and interviewed 140 persons, including health personnel from the public and private sectors, and non-health personnel. Findings. In 5 years, senior staff built a QA structure and capacity throughout Zambia, generated enthusiasm for QA, and initiated teamwork on quality of care issues by motivated health staff. Some challenges remain: lack of integration of QA, uncoordinated standards, weak methods of standards communication, poor measurement of compliance with clinical care standards, constraints on the work of the quality improvement teams, and inconsistent support systems. Recommendations. The evaluation team made recommendations regarding a national QA policy, mechanisms to develop standards of care, monitoring of health providers' performance, needs of quality improvement teams, training in QA, and documentation of QA activities. Conclusions. Despite its success in covering the entire country with a network of QA coaches and trainers, the capacity of the public sector to sustain QA activities at the central and district levels remains a challenge. Lessons from the Zambia experience can benefit QA programs in other developing countries.