Final Report: Case Study on the Health Network Quality Improvement System (HNQIS)

HNQIS is an electronic tablet-based application designed to improve quality of health services and effectively reach health impact at scale. The system is composed of four modules that support healthcare supervisors to plan supervision visits, assess providers' quality of care, improve providers' quality of care through tailored feedback, and monitor quality improvements over time. HNQIS has been customized and implemented in diverse contexts across 19 countries in sub-Saharan Africa and Asia to reinforce standards of care across 13 different health areas. The system has been introduced to address the efficiency gaps of a paper-based system, where data collection, entry, and management were time-consuming. HNQIS works offline, allowing supervisors to access the application without consistent connectivity, and data is sent upon completion of the assessment or on a routine basis. The HNQIS application is Android-based and was developed by PSI in collaboration with EyeSeeTea, Ltd and KnowTechTure (KTT), who developed the Android codes and made the link with DHIS2. BAO Systems supports DHIS2 server configuration to host the application. In each country and for each health program area, the HNQIS content and algorithms must be customized within the standard modular process and according to national guidelines. The HNQIS process is guided by four modules to support supervisors through the plan-assess-improve-monitor cycle. The process is consistent for HNQIS application around the world, though scheduling criteria, QoC threshold scores, feedback, and data dashboards for monitoring may vary based on context and need. The step-wise customization process includes responding to the expression of interest, developing the QA checklist for service areas, configuring the checklist within the app, implementing user testing, releasing the final country version of HNQIS, launching and rolling out to QAO supervisors, and conducting end-user and analytics training. Supervisors use the HNQIS app to calculate the quality of care scores for providers in their networks, schedule support visits, and prioritize provider support. HNQIS serves as a human resources management tool, given its visit-scheduling functions. The system assists quality improvement teams to assess quality of care of providers' services, measure provider proficiencies in respective skills, and highlight missed critical steps. QAOs use the HNQIS app to plan, assess, monitor, and follow-up with providers using HNQIS as a supervisory tool. HNQIS has been implemented in various countries, including Ghana, Côte d'Ivoire, Bangladesh, Ethiopia, Niger, Somaliland, and South Africa. The system has been customized to meet the specific needs of each country and health program area. In some contexts, supervisors preferred using both reporting mechanisms (paper and digital) until they gained confidence in HNQIS data capture. The system has been shown to improve quality of care and increase efficiency in supervision reporting.