IMPLEMENTING QUALITY A MISSING PIECE WITH A NEED FOR PROCESS OF BEHAVIOR CHANGE: A CASE FOR IMPLEMENTING QUALITY CB-IRS DELIVERY MODEL IN ZAMBIA

Background: In the wake of increasing malaria cases in Zambia, IRS has been coming under increasing accountable pressurefromthe publicfor quality IRS performance and its decentralized approach. In response, anew IRS approach Community-BasedIndoor Residual Spraying (IRS)Delivery model has been introduced in the country and institutionalized in the community health care system.The objective of this study was to introduce quality assurance approach methods to the model in terms of structure, process and outcomes for quality performance. Materials and Methods: We reviewed both published and unpublished documents, articles, papers on quality service delivery and explored field experiences and the understanding of IRS service delivery. The Donabedian model has been found to lead to improvements of quality that in turn could improve the health outcome of the community. Equally, dimensions of quality were analyzed under effectiveness, efficacy, acceptability, equity and relevance to IRS delivery of services and best approaches. Results: Quality assurance becomes strong and successful when its well organized with features of a health atmosphere that motivates IRS teams, Spray operators (SOPs), and the house hold owners, thus becoming a common goal as a result of good level management. The District IRS Operational Committee, typically must possess quality assurance superior technical skills and expertise. However, it is not only quality assurance guidelines that strengthen team building but also established rules, processes, tracking ofprogress, IRS quality assurance learningenvironment, improvements and leadership support initiatives. These could be supplemented by enabling tools and a nurturing qualityfriendly atmosphere within the IRS teams and SOPs as front liners. Donabedian model for improvement of quality has been widely adopted in the hospital care set up, but hasnot yet been fully recognized, utilized and validated in the vector control system. Conclusion: The study suggests that the Donabedian`s structure-process-outcome isa valid modelfor implementingquality CB-IRS Delivery model in the IRS program campaign. The interventions that perform well in terms of structure tend to perform better forquality service delivery processes, that in turn have favorable influence on the community health status outcome.