System for conducting assessments of service quality at CBVCT centres Structured and standardized data collection tools for assessment of service quality at CBVCT sites should be developed as part of a protocol of good practices. Quality assurance (QA) refers to planned, step-by-step activities that let one know that testing is being carried out correctly, results are accurate, and mistakes are found and corrected to avoid adverse outcomes. Quality assurance is an ongoing set of activities that help to ensure that the test results provided areas accurate and reliable as possible for all persons being tested. Quality assurance activities should be in place during the entire testing process this means from the time a client asks to be tested using the rapid HIV test to providing the test result. For improving the quality of CBVCT, a quality improvement framework and tools are available 34 These could include surveys of clients at facilities that provide testing. This can monitor the quality and acceptability of services and identify problems. It can also be done in the context of operational research or program evaluation. The protocol for collecting and analyzing the information that each country develops mayor may not be extensive, depending on who is responsible for conducting the assessment, the number of sites to be covered, the diversity of CBVCT service delivery models in the program, and the resources allocated for assessing service quality. Resources are needed to establish and maintain a QA program, no matter how simple the testis. Someone designated by the management of the CBVCT centre should oversee the programme and ensure the necessary staff and supplies are available. Knowledge about national/regional regulations is needed. The quality process is intended to combine the myriad of guidelines and requirements normally found in many different locations. Every new CBVCT’s staff member should be able to read this plan and understand the ins and outs of HIV testing there. However, it is also intended to function as a reference tool for more experienced testers and counselors, when special circumstances or questions arise. 34 WHO (2010) Handbook for improving HIV testing and counselling services http://whqlibdoc.who.int/publications/2010/9789241500463_eng.pdf
46 What is the value of feedback for quality assurance Site-level CBVCT data are generally forwarded to a more central site such as a district, province or state office where they maybe further aggregated and then forwarded to the national level. ME data have a use at every managerial level and should be actively reviewed. Information collected for the national HTC program should be made available at all levels (i.e. national, sub national, and CBVCT site) through strategically designed feedback mechanisms. Communication between management levels should flow in two directions just as systems for reporting data to higher levels of management are established, so should feedback and data analysis flow regularly back down. The dissemination of program results from data analysis and use of findings for program improvement and policy development is a key step in the ME process. This includes allowing sites to understand their performance in the context of how other sites are performing and can encourage sharing of best practices and joint problem-solving among sites. Broader sharing and discussion of CBVCT programmatic data at all levels is intended to lead to improved service provision and delivery to identify target populations in need of strengthened CBVCT efforts to motivate programme staff and stimulate programme performance to address issues in data quality to ensure that CBVCT sites, as well as district and national offices, realize the benefits of dedicating resources to the ME process.