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QA Brief. 1996 Summer; 5(1):19-21.In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.
Surveillance of acquired immunodeficiency syndrome in Africa: an analysis of evaluations of the World Health Organization and other clinical definitions.
EPIDEMIOLOGIC REVIEWS. 1994; 16(2):403-17.In order to improve public health efforts to combat the HIV pandemic, a system for surveillance of HIV and AIDS is needed. Definitions used for case reporting are at the heart of such a system. In many parts of Africa, however, facilities for diagnosing HIV infection and its subsequent complications are unavailable, and the definition developed by the US Centers for Diseases Control and Prevention (CDC) for use in developed countries is often impractical in Africa. The World Health Organization (WHO) in early 1985 therefore proposed using a provisional case definition of AIDS based principally upon clinical criteria. Developing a clinical definition of AIDS in Africa, however, is also complicated. The nonspecific nature of many of the signs and symptoms of HIV infection as well as the clinical redundancy between HIV and other epidemic health problems make definitive identification of any single disease problematic. Evaluation of the surveillance definition of AIDS in Africa is complicated by the lack of an accepted standard for comparison. Most studies in the field have used HIV serology as the standard, while others have employed the CDC definition for AIDS, giving the evaluations a certain relativity. This paper reviews available information on the WHO definition and other clinical definitions for AIDS in Africa in order to analyze their various field evaluations and explore the use of such definitions in the African context. Sections discuss surveillance clinical case definitions for African AIDS in adult and pediatric populations, clinical case definitions of African AIDS in adult and pediatric populations, sensitivity and specificity, the WHO clinical case definition for HIV epidemiologic survey, clinical definitions for AIDS in clinical practice, and working toward the improvement of the clinical definition of AIDS.