Zambia’s under-resourced public health system will not be able to meet its health-related Millennium Development Goals without a substantial decrease in death rates, but this will depend not only upon increasing access to healthcare, but also upon improving the quality of care that is delivered.
Better Health Outcomes through Mentoring and Assessment (BHOMA) is a multiple intervention study started in 2011. Funded by the Doris Duke Charitable Foundation, its aim is to improve population health outcomes through the introduction of clinical forms, mentoring of clinic staff, and monitoring of quality of care in rural outpatient clinics with a real-time electronic data system.
There are 46 clinics that are BHOMA study sites in Luangwa, Chongwe and Kafue districts in Lusaka province. Working closely with the Ministry of Health and Ministry of Community Development Mother and Child and the Zambia Integrated Systems Strengthening programme, BHOMA teams implement:
Mentoring clinic staff to improve healthcare provider skills
Providing practical tools, such as patient forms and wall charts
Supporting and training pharmacy staff
Ongoing performance assessment and evaluation
Supporting essential resources such as equipment, drugs, supplies, staff, and infrastructure
Training Community Health Workers
Improving referral and follow-up systems using mobile phones
Involving Neighbourhood Health Committees
Training Traditional Birth Attendants and encouraging them to refer pregnant women to health clinics for care
Health Systems Improvements
Training of health staff
District based activities and support
Close collaboration with Ministry of Health
Monitoring and Evaluation
Using a unique, innovative and secure data capturing system that allows access to real-time data, BHOMA staff collect patient information to track programme effectiveness and improve daily programming. Data is captured within the community by health workers using mobile phones and in the health facility with patient intake forms and promptly entered into the computer data system.
Since the initiation of the BHOMA project, we have enrolled over 390,000 patients, recorded over 800,000 patient consultations and trained over 1400 health care workers.
Evaluation of the BHOMA Project will will be conducted by the Zambia AIDS Related Tuberculosis Project (ZAMBART) using household and facility surveys, healthcare staff and community member interviews, and programme costing methodologies.
Patient-provider relationships are critical to protecting population health. The BHOMA project aims to improve population health outcomes by substantially improving this interaction. Success will hinge upon the ability of clinical mentoring and continuous quality improvement to improve clinical service delivery. With noticeable improvements in the quality of available health services, communities will recognise their value and increasingly utilise them.