Component 2: Delivery of Evidence-based, Quality PHC Services

The USAID/Primary Health Care Project in Iraq (PHCPI) strategic approach to strengthening the quality of Primary Health Care (PHC) services incorporates innovative Quality Improvement (QI) models, emphasizing community involvement; compliance with evidence-based standards of care; use of facility-based QI teams in combination with supportive supervision; as well as assistance to prepare PHC clinics for accreditation. Under project component  2, USAID/PCHPI will work closely with counterparts within the Ministry of Health (MoH) to focus on establishing standards of care, developing and introducing quality improvement programs, expanding high-quality in-service training programs, developing platforms to enhance the quality of care provided in the private sector, and developing an agenda for conducting research to fuel further evidence-based improvements. To ensure the availability and utilization of high quality clinical services, especially for women, children, and vulnerable or displaced populations, the project will focus on the following:

Improving Quality Clinical Care standards
In close collaboration with the Directorate of PHC Services and other stakeholders, USAID/PHCPI will help the MoH to update/ revise treatment protocols and clinical standards and guidelines for the existing basic health services package in Iraq. At the national level, USAID/PHCPI will provide assistance aimed at developing sustainable institutional capacity within the MoH to successfully implement policies for national PHC Standards. The project team will work with partners at the provincial and district levels to improve human resources capacity through pre-service and in-service training programs for physicians, nurses and other cadres of health providers. The Clinical Service Guidelines Handbook will offer a collection of easy-to-use clinician’s reference guides with treatment protocols for each category of primary care services offered at PHC clinics. USAID/PHCPI  will also work with the MoH to develop and implement Clinical Quality Improvement interventions, assess and improve clinical supervision systems, and develop stronger patient referral networks.

Collaborating to emphasize Quality improvement
USAID/PHCPI will work with MoH to update practices and tools for quality improvement using state-of-the-art QI methods. The project team will assist the MoH in introducing the PHC QI Program through both clinic-based QI teams and multi-clinic Improvement Collaboratives. USAID/PHCPI will integrate many of the basic elements of traditional health programming (standards, training, job aids, equipment and supplies) with modern QI elements (team work, process analysis, monitoring of results, client satisfaction) to create a dynamic learning system where teams from different sites collaborate to share and rapidly scale up strategies for improving the quality and efficiency of health services in a specific technical or management area.

Developing Research Agenda
USAID/PHCPI will work with MoH and university partners to develop and facilitate a research agenda to determine and apply evidence based solutions to support sustained improvements in demand access and quality provision of PHC systems. The project will assist in translating research results into specific improvements in policy design and implementation, resource management, and clinical processes
which in turn will contribute to improved quality of care. USAID/PHCPI will assist in articulating a research agenda to address most pressing PHC concerns, such as increasing compliance with health systems management policies, clinical care practices, and community participation.

Building public-private partnerships
With the MoH, USAID/PHCPI will conduct a rapid situational analysis in targeted provinces to assess the quality of care provided by physicians working in the private sector (many of whom work for the public sector on day shifts). Based on the results, a strategy will be developed to improve the quality of private sector care and increase the involvement of private providers in key PHC improvement initiatives, for example, to improve disease notification. Other innovative approaches may include engaging with private enterprises such as cellular communication service providers to develop strategies to disseminate public health messages, while providing suppor t for disease surveillance.