In recent years, national health programs have expanded their focus to include not only improving access to care, but also improving the quality of care received by patients and communities. As part of quality assurance for many clinical diseases, including tuberculosis (TB), international and national evidence-based standards and guidelines have been developed. Having explicit standards and guidelines helps ensure high-quality care, better health outcomes, and cost-effective treatments. In addition, they provide a reference point for assessing provider or system performance and quality of care. It is important to note, however, that adherence to these guidelines is not just a result of the development and dissemination of them, but of integrating the guidelines as part of a quality management program.

The USAID funded TB CARE II project recently conducted assessments in Bangladesh, Zambia, and Kenya to investigate factors influencing provider compliance to evidence-based TB guidelines and standards highlighted numerous factors that affected compliance. Overall, it is clear from the findings that a number of challenges continue to affect the ability of health providers to adhere to clinical and programmatic guidelines to maintain a consistent quality of TB services.  These challenges are related to provider skills and knowledge gaps, a lack of monitoring and supervision, and regular reviews of performance data. The Quality Improvement Handbook provides key principles and operational steps that will assist in improving the quality of TB and MDR-TB services in resource-constrained settings.

This manual is intended for health personnel working in health facilities that diagnose and treat TB patients as well as for administrative staff working in the management of health services at the health facility, subdistrict, or district levels. The purpose of this manual is to explain how to apply quality QA improvement strategies to help decrease the gap between TB quality of care standards and actual performance. Specifically, it provides guidance to Quality Improvement Coordinators to: 1) Identify and prioritize problems based on data and 2) develop and monitor action plans to solve problems.