AOGU in partnership with PACE

As part of its quality improvement plan, PACE contracted AOGU to undertake a medical audit of selected PROFAM facilities in Eastern, Central and South-Western Uganda. The aim of the quality assurance audit was to assess adherence to quality standards and the quality of care provided in 30 PROFAM clinics that provide Long term Reversible Contraceptives (LARCS). It was conducted between 13th and 23rd February 2017. The specific objectives of the audit were to assess the providers and facilities for minimum standards regarding, licensure, infrastructure, equipment, commodities, and supplies. Also, assessing adherence to five standards (during performance of the procedure), namely provider technical competence, client safety, informed choice, privacy and confidentiality, and ensuring continuity of care. The methodology employed involved documentary review at regional offices (assessment of the availability and quality of documents including policies, protocols, supervisory records and procedures as spelled out in the PACE quality improvement plan); direct observation, assessment and documentation of service delivery (intrauterine contraceptive device and implant insertion and removal), and overall assessment of the service delivery environment.

The audit showed that while all providers were licensed qualified professionals, some facilities had providers who had no documentation of having received service provider training, whose competence was substandard, or whose basic knowledge and skills were deficient. Besides, some providers did not follow the client screening protocols for eligibility, pregnancy check lists, general infection prevention, and equipment preparation or performing the procedures. Also, all providers were aware of adverse events. Indeed all facilities had active adverse events protocols and providers knew what to do in case of such problems. Besides, most facilities did not provide informed choice of all available methods. Additionally, not all facilities offered both visual and auditory privacy to the clients, or provided safe storage or confidentiality of client records. However, for most facilities, modest procedures and activities were in place to ensure continuity of care.