Country experience in organizing for quality: Zambia.

This article describes the activities of the Quality Assurance Program (QAP) within the Central Board of Health (CBH) in Zambia. QAP provides training and technical support to quality assurance (QA) to District Health Management Teams (DHMTs) and health centers. DHMT members were trained as QA facilitators. Training in target districts first addressed the setting and monitoring of standards. Training later focused on development of problem solving capacity. Health providers were trained by central staff to self-assess to measure performance to agreed standards and to respond to client-user needs. The Directorate of Monitoring and Evaluation provides training and oversight in QA to the DHMTs and their health centers. Training generally consists of a sensitization workshop week-long training in dynamic standard setting 5-day training in development of monitoring indicators at the district and facility level and 2-week skills training in use of QA tools. CBH monitors quality by quarterly performance audits supervision visits by DHMTs and the health management information system (HMIS). The new HMIS was piloted in 15 districts and is being established nationwide. CBH developed a manual of standards for 6 priority health areas: reproductive health and family planning HIV/AIDS and sexually transmitted diseases child health and nutrition tuberculosis and water and sanitation. 85 QA teams operate in 90% of the districts. Problem solving methods have led to team building among professionals increased competence of staff to address problems and capacity building for management.