Optimizing Performance and Quality in Central America

Where has OPQ been used?

  • Health centers, hospitals, and multi-sector networks

Key lesson:

  • Performance standards, OPQ teams, and annual assessments improve service delivery

The USAID-funded Central America CapacityPlus Project (2011–2016) is currently operating in five countries—Belize, Costa Rica, El Salvador, Guatemala, and Panama—to deliver quality comprehensive and stigma-free HIV/AIDS care and treatment to people living with HIV.

In Central America, the goal of Optimizing Performance and Quality (OPQ) is to strengthen human resources for health to provide quality services. IntraHealth began its work with the Central America Capacity Project (2009–2013) using the Performance Improvement (PI) methodology. In 2012, the organization transitioned to its new OPQ methodology, which places greater emphasis on stakeholder ownership, identification of performance strengths as a tool for growth, and expansion of performance factors.

  • Facility performance: As of March 2014, there are OPQ activities in 12 health centers in Guatemala alone, as well as in 57 hospitals in the region as a whole. The OPQ instruments cover 300 performance standards across 18 service areas, and these instruments are revised annually by each individual country. At the 57 hospitals across the region, OPQ teams have conducted baseline and annual follow-up measurements with the goal of bringing each facility’s overall performance score to at least 85%. Based on average scores of 50 hospitals at baseline and third measurements, all 18 service areas have improved, with the greatest gains in laundry services, waste management, morgue, management, outpatient, and biosafety. Likewise, the average overall hospital performance score has steadily increased in all five countries.

OPQ Service Areas

1. Outpatient
2. Emergency
3. Surgery
5. Internal medicine
6. Pediatrics
7. Intensive care
8. Diagnostic imaging
9. Nutrition
10. Counseling
11. Biosafety
12. Waste management
13. Laboratory
14. Blood bank
15. Pharmacy
16. Laundry
17. Morgue
18. Management


  • Network performance: The Central America CapacityPlus Project is also applying OPQ in 27 multi-sector networks at the community level as part of the Coordinated Community Response model. This innovative use of the methodology brings various actors together to organize, improve, and monitor a coherent response to HIV prevention, care, and follow-up. All networks receiving project support and assistance have conducted a baseline performance measurement. Baseline assessments for 27 networks showed that on average their services scored 35% against performance standards. One year later, the average network performance score increased to 56%, with substantial improvements in counseling, diagnosis, and antiretroviral therapy adherence. Assessment instruments for the Coordinated Community Response model cover six performance areas related to pre- and post-test counseling, clinical care, treatment, support services, prevention, and management.

Formal OPQ institutionalization efforts, which began in 2010 and are part of the project’s long-term sustainability strategy, have been successful at both the central and local levels. IntraHealth has conducted OPQ implementation trainings of ministries of health and social security institutes officials, technical officers of national HIV/STI programs, and hospital quality control representatives. There have also been individual country gains in formal institutionalization of OPQ, such as governmental adoption measures, request for expansion of the methodology to national coverage, and use within ministries of health.

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