Systems Analysis and Improvement to Optimize the Prevention of Mother-to-Child Transmission in Central Mozambique

Abstract

University of Washington <bold>Abstract</bold> Systems Analysis and Improvement to Optimize the Prevention of Mother-to-Child Transmission in Central Mozambique Sarah Gimbel-Sherr Chair of the Supervisory Committee: Associate Professor, Joachim Voss Biobehavioral Nursing and Health Systems <bold>Background</bold>: Despite significant increases in global health investment and the availability of low-cost, efficacious interventions designed to reduce mother to child HIV transmission in low and middle income countries with high HIV burden such as Mozambique, the translation of these scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. <bold>Methods</bold>: We reviewed models and theories of change from a range of disciplines, including management sciences, nursing, medicine, engineering and sociology, that endeavor to explain the natural process of diffusion of innovation both at individual and group levels. Considering our hypothesis that health outcomes can be improved by identifying and reducing systems inefficiencies and improving program effectiveness in complex, multi-step health services - such as prevention of mother-to-child HIV transmission (pMTCT) - we subsequently reviewed novel analytic techniques to assess workflow that have been applied to health care settings and applied them to the model. <bold>Results</bold>: A conceptual framework combining literature on systems analysis, quality improvement, and change theory with analytic techniques from industry, was developed as a foundation for the development of a systems analysis and improvement approach for application to pMTCT services in central Mozambique. The main practical elements of this framework include district and facility-level health managers' use of routine data to identify and rank health systems factors and service delivery approaches associated with high and low performance of pMTCT services, the subsequent application of a cascade systems analysis tool and process mapping by facility-level health care teams to understand their current systems and identify the most appropriate areas for intervention for service improvement, and an associated performance improvement approach to apply in service delivery facilities. <bold>Conclusion<bold/>: Enhancing the implementation of pMTCT interventions through appropriate systems analysis and improvement approaches can potentially reduce attrition along the pMTCT care cascade, leading to dramatic improvements in infant and maternal outcomes. This conceptual model is novel as it practically engages both district and health facility managers in the process of understanding their system, identifying bottlenecks, as well as generating and testing solutions across complex stepwise health care interventions such as pMTCT.