DIGITALIZED SELF-REGULATORY QUALITY IMPROVEMENT SYSTEM (SQIS): TOOL FOR QUALITY IMPROVEMENT IN THE PRIVATE SECTOR, UGANDA

The Self-regulatory Quality Improved System (SQIS) is a self-assessment tool developed for the private health facilities. It supports facilities to evaluate and monitor quality,coordinate, plan and mobilize resources.

This concept has been developed by the Ministry of Health (MOH), Uganda Medical and Dental Practioners’ Council (UMDPC), Allied Health Professionals’ Council (AHPC) and Uganda Nurses and Midwives’ Councils (UNMC) and Uganda Healthcare Federation (UHF).

BACKGROUND

The Ministry of Health (MOH) SQIS platform was launched in 2016 but was later upgraded in 2020 to become SQIS+, this can be applied to any facility irrespective of the size and complexity of services offered. The SQIS is sufficiently detailed to allow the user in-depth check of the prevailing stndards of care examining 16 key service elements including leadership and governance, infection prevention and control, medicines management, diagnostics, customer interface as well as the business and finance processes in place to complement service delivery. The digital tool kit can identify areas of weakness that can be addressed to meeting registration and licensure requirements.

MOH in partnership with UHF and the Counsel for Health Service Accreditation of South Africa (COHSASA), with financial resources provided by Private Sector Foundation Uganda(PSFU) in partnership with Mastercard Foundation under the COVID-19 Economic Recovery and Resilience Response Program (CERRRP) and USAID developed and digitized the SQIS+ platform which is linked to an eLearning platform with modules designed to address knowledge gaps identified through the self-assessment process. At no cost, the SQIS assessment can be completed online at https://sqis.health.go.ug or download an android mobile application (SQIS plus) for the offline version.

SQIS Upgrade includes some of the new features as stated below;

The SQIS+ assessment focuses on 16 service elements i.e Governance and Leadership, Human Resource, Essential Cre, Maternity, Labaratory, Client Provider Interactions, Infrastructre, Equipment, Health Promotion & Education, Infection Prevention and Control, Occupational Health and Safety, Medicines & Supplies, Records, Imaging and Radiography, Theatre and Mortuary.

1. SQIS+ has a more comprehensive scoring structure based on Compliant, Partially Compliant and Non-Compliant scores.
2. The scope of services assessed using SQIS+ increased from catering only for general health facilities to including specialized Standalone facilities i.e., Standalone Lab, Pharmacy, Radiology, Dentistry and Ophthalmology.
3. SQIS+ provides a risk prioritized and time bound quality improvement plan based on the assessment.
4. SQIS+ has an analytics dashboard with scaled access rights to monitor performance of health facility assessments at the different levels.
5. SQIS+ has an analytics dashboard with scaled access rights to monitor performance of health facility assessments at different levels.
6. SQIS+ has an administration assessment component for Business and Finance of the health facility to identify gaps and provides a finance improvement plan generated by the system after the assessment.
7. In-built eLearning Training: SQIS+ is linked to the UHF eLearning platform which offers capacity building training modules that support those assessed to address identified gaps. While the SQIS generates a quality improvement plan unique to the facility assessed, to complement implementation, users will have free access to the training modules.
8. The SQIS+ has a client feedback mechanism, allowing health consumers that visit assessed facilities to score their experience at the facility and share the feedback with the facility ownership for continuous improvement. Feedback will also be utilized to derive performance league tables to identify poor performing facilities for support and to inform programs such as Heroes in Health Awards on which facilities are providing outstanding service, from across the country.

BENEFITS OF SQIS+

• The blended tools into SQIS+ offers a robust single self-assessment tool that addresses a key challenge of regulating the private sector in regards to inconsistency of multiple tools and a prescriptive approach.
• The digitization enables analysis, comparisons and real-time quality of care data capture of standards across the country
• The eLearning platform will provide a virual support pack in the form of templates and forms that can be downloaded and personalized to the participating facilities brand.
• The system is dynamic enough to capture consumer feedback and give facilities a support channel similar to support supervision.The system has dashboards that illustrate the self-assessment data, profiles for facilities, supervisors at district level and oversight profiles for stakeholders at national level.
• The private sector platform meetings also enable SQIS+ assessed facilities to hear directly from regulators and local government leaders on issues pertaining to the private health sector. This initiative has enabled hundreds of facilities to benefit from training opportunities, capacity building interactions, and support to report data into the national reporting system DHIS2.

USERS OF THE SQIS+ TOOL

1. Hospitals and clinics.
2. Medical and health centers
3. Domiciliary
4. Laboratories
5. Dental clinics
6. Ophthalmology
7. Radiology
8. Pharmacy units

RIPPLE EFFECTS AND ACHIEVEMENTS OF SQIS+

1. The SQIS+ has been made mandatory for the private health facilities as one of the requirements for annual license renewal and registration by the regulatory councils. This was requested by the Hon. Minister of Health before the launch of the tool.
2. The private health facilities have access to SQIS+ to facilitate implementation of QI interventions in the service delivery outlets. The system provides a Quality Improvement Plan that guides the QI teams at facilities on the gaps identified.
3. SQIS+ supports regulation of private health facilities through a transparent platform that allow facilities to self-assess and get ready for licensing. Self-assessment is key especially at private health facilities with minimal supervision.
4. SQIS+ has helped to build conduit for capacity building in the private health facilities through the eLearning platform where modules are available as guided by Ministry of Health and regulatory councils e.g. modules on COVID 19 case management, Tuberculosis, Malaria case management etc.
5. As we shape the medical credit scheme, SQIS+ will be used for decision making for who is eligible for financing basing on the assessment results, highlighting the areas that need funding.
6. Over 1200 private facility have begun the process of self-assessment using the SQIS tool. These facilities benefit from technical assistance and guidance, access to monthly private sector online platform meetings that facilitate peer to peer support, guidance, ideas and experience sharing.
7. SQIS+ assessments have been taken up by health facility managers to monitor and assess quality gaps at any given time of their convenience since the system is accessed on internet.
8. By end of June, 66 private sector facilities had created accounts and self-assessed with the online SQIS+ standards. The facilities received system-generated quality improvement plans ( QIPs) to guide implementation of the required interventions based on the gaps identified by the assessment.