1. Aisa Mhalu, Hellen Siril, Lisa Hirschhorn, Roseline Urio, Justina Tito, Prisca Shirima, Ashura Polle, Theodora Mbunda, Ali Kaduma, Faida Emil

2. Background The Management and Development for Health (MDH) organization has been supporting implementation of quality improvement(QI) activities HIV care and treatment centres in DSM region since 2004. By Sept 2013 a total 88 CTC sites and 204 RCH sites in Dar-es-salaam region were being supported Along the course of this support we learn that in order to implement QI activities effectively facility require QI team with active members, quality improvement plan and documentation of QI activity. Regular monitoring of capacity to implement QI activities is therefore important

3. Objective: To assess CTC Quality Improvement team working capacity in DSM-MDH supported sites.

4. METHODOLOGY Baseline review of 10 large (enrol >5000 PLHIV) CTC sites was done in October 2010 A simple site checklist which as adapted, then incorporated into the project quarterly capacity building support to assist supervisors and site leaders to monitor and report the QI team working capacity. We measure core domains of QI work at site level including existence of the team, team structure, identify training needs, documented QI activities, and areas of support. The tool was filled by QI team members at the CTC sites at the end of every quarter. The compiled data was entered into computer using excel spread sheet The report of data analysis was shared during a monthly technical meeting. Identified gaps were addressed in the site supportive supervision, mentorships visits and training.

6. FINDINGS By 2011 twenty six out of 27 CTC sites responded and 24 out of 27 sites responded in 2012 The proportion of CTC sites with quality improvement team increased from 60% at baseline(2010) to 100% in the period of two years (2011, 2012). Proportion of CTC with active QI projects increased from 60% at baseline( 2010) by 92% in 2012. Keeping CTC QI meeting reports also increased from 50% in 2010 of the CTC sites to 79% in 2012. There was slight improvement in the site having consistent QI plans.

8. Self reported Barriers to QI

9. Conclusion and recommendation Regular monitoring of CTC QI team activities through integrated tools can assist on identification of areas which need further technical support. It can also identify site which can serve as sources of peer-to-peer learning to further strengthen and expand the quality improvement work.

10. Acknowledgement Ministry of Health and Social welfare, DSM city council and all sites that participated PEPFAR program through CDC Tanzania

11. THANK YOU