Performance Improvement Approach in Namibia

Where has OPQ been used?

  • Faith-based and public health facilities

Key lesson:

  • Implementing and monitoring action plans that address gaps and their root causes improves performance

Since October 2009, the Performance Improvement Approach (PIA) has been used by various faith-based and public health facilities to support the IntraHealth-led HIV Prevention, Care, and Support project in Namibia. Trained facility managers and providers have used PIA to identify gaps in HIV counseling and testing (HCT), voluntary medical male circumcision (VMMC), and emergency obstetric and neonatal care (EmONC) in their settings.


In October 2009, IntraHealth oriented a small team to PIA, developed a trainer guide, and created several PI instruments which included an observation guide, an exit interview guide, and observation checklists. The team trained fourteen program managers and providers in Northwest Namibia in PIA, including a clinical practicum for applying PIA to HIV/AIDS services. Participants developed individual- and facility-based action plans for applying performance improvement in their jobs, units, and sites.

Copyright IntraHealth International 2014PIA was integrated into further training in HCT, PMTCT, and VMMC services, and over the next two years, IntraHealth supported the training of trainers, as well as managers and providers in all IntraHealth-supported sites. In all cases, participants identified organizational gaps and root causes, selected key interventions, and developed and implemented action plans for improving services in their facilities with IntraHealth follow-up and support.


IntraHealth and the Namibian Ministry of Health and Social Services (MoHSS) applied PIA to improve the quality of maternal and neonatal health care services and reduce neonatal mortality in four district hospitals of the Kavango region. Starting in September and October 2012, providers received training in EmONC life-saving interventions, including application of PIA. Coaching and mentoring activities, as well as monitoring and supportive supervision activities, were also conducted.

Project Results

The results of these PIA implementation activities were significant. A follow-up conducted in June 2010 on HCT and VMMC services showed that three out of five participating facilities had successively resolved their identified gaps. The HIV Prevention, Care, and Support project presented a poster of these results at the 2012 International African AIDS Conference. At Rehoboth hospital, the monthly VMMC uptake increased from four patients in November and December 2012 to sixteen patients in January and February 2013. Odibo health center’s percentage of HIV-positive pregnant women receiving ARV treatment for PMTCT increased from 70% before November and December 2012 to 100% at the evaluation. At Nyangana hospital, HCT increased from 82% to 185%, far beyond the target, three months after the introduction of PIA.

An EmONC follow-up conducted in March 2013 showed improvements in performance standards, including partograph initiation at the appropriate time (from 68% to 83% in Nankudu district hospital and from 62% to 65% in Kavango district hospital), accurate data plotting (from 68% to 83% in Nankudu and from 42% to 76% in Kavango), appropriate action (from 80% to 96% in Nankudu and from 73% to 76% in Kavango), and partograph quality (from 45% to 58% in Nankudu and from 33% to 38% in Kavango).

PIA has clearly made a difference in health settings where it has been applied. IntraHealth’s future implementation goals include retaining trained personnel, supporting the involvement of local management teams, and synergizing PIA with other quality assurance approaches implemented or promoted by the MoHSS and partners in Namibia.

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