Overall, since inception in 1999, much progress has been made in the following areas:
Institutional set up and improvement.
Diploma course: establishment, expansion and upgrading to a Masters.
Short courses: development and expansion in number of courses and participants.
Operational research resulting into guidelines and manuals.
Over 50 policy guides, manuals, posters and publications, disseminated and some used routinely in the region.

Quality Of Care
The centre has managed to put QOC agenda in medical and health training, policy and management guidelines, research and national/district health plans in the region.  It has also institutionalized directly or through ripple-effects various approaches to quality of care and performance improvement in health service delivery.  In Uganda, the quality and coverage of immunization of children improved from 2003-2005 due to quality assurance and performance improvement approaches (PIA) provided by the RCQHC.  PIA has also made positive changes in the management of malaria in pregnancy in Mkushi in Zambia and in TB control and management in Uganda (Pallisa, Kumi and Apac) and Tanzania (Iringa).  In Malawi the centre’s Essential Nutrition Actions (ENA) have been found to be useful at facility level in Malawi and Lesotho where they have been practically applied.


Child health and Nutrition
The RCQHC has been involved in promoting better nutrition for people living with HIV/AIDS (PLHAs), infant and young child feeding, maternal anaemia prevention and management of diarrhoeal disease using oral rehydration salt and zinc.  Through training, counseling and guidelines, better practices, these child health and nutrition interventions are being applied and spread among communities in the region.  Some of the guidelines and manuals include:

Developing and applying national guidelines on nutrition and HIV/AIDS.
Nutrition and HIV/AIDS: A training manual
Counseling mothers on infant and young child nutrition.
Counseling guidelines in nutrition for PLHAs.
Anaemia prevention budge: Guiders’ training manual.
Anaemia prevention budge:  Award handbook.

The centre has embarked on scaling up initiatives for child survival.  A practical example was the immunization project to improve coverage in Luwero district in Uganda.  A Child Survival Forum was held.  The idea of comprehensive paediatric HIV/AIDS care was conceived.  From this idea, the centre has now developed Comprehensive Paediatric HIV/AIDS Care Hand Book for health workers in the region.  The advocacy on taking “child survival to scale” is a challenge the centre has taken up.

Paediatric HIV/AIDS
Priority areas for the RCQHC with regard to HIV/AIDS are children affected by HIV/AIDS, Voluntary Counseling and Testing (VCT) and Behaviour Change Communication.RCQHC established the African Network for Children Affected by HIV/AIDS (ANECCA).  ANECCA’s philosophy is no matter your level of resources, there is always something that you can offer HIV-affected children. Through training and workshops, ANECCA came up with “Paediatric ART characteristics in Africa” which became a reference document for the development of Paediatric ART programmes in Africa.  Also, “Rapid Implementation of training in paediatric HIV care in Africa: The contribution of the ANECCA Curriculum” was made.  This highlights the materials and steps in scaling up paediatric HIV care and treatment in Africa.  A major milestone has been the publication in 2004 of “Paediatric HIV/AIDS in Africa” which has been translated into French and is in use in 25 countries in the region.

RCQHC has facilitated and conducted several training sessions throughout the region to build capacity at facility level for managing paediatric HIV/AIDS.  The centre has collaborated with UNICEF and WHO to stage paediatric AIDS, and is now carrying out a study to validate the clinical diagnosis of paediatric AIDS.  The centre has also produced guidelines and a training manual on paediatric HIV counseling.

Reproductive Health and Family Planning
The centre developed performance improvement in the management of maternal anaemia involving both pregnant and expectant mothers.  The centre also published “Improving the quality of FP services in Uganda” as an effort to scale up family planning services, which had become relatively neglected.  In 2004, the centre published “Integrating gender into reproductive health services: a guide for health workers in the region”.  

In 2002, the centre, through “Implementing Best-practices Initiative in Africa” launched the Repositioning Reproductive Health in Africa:  Linking Challenges with Best Practices.  The goal was to improve access and quality of reproductive health through a systematic approach.  Recent initiatives have been on expanding the use of Active Management of the Third Stage of Labour (AMSTL) to prevent maternal death, using politicians (members of parliament) to advocate for birth preparedness and safety.  Through professional associations, guidelines for improving the quality of fistula management has been developed, awareness and management of gender-based violence has been improved; and advocacy for FP using the media has been embarked on.

Infectious Diseases
The centre has been attempting to institutionalize performance improvement in infectious disease control - mainly TB and Malaria.  “A guide to quality antenatal services: PIA in malaria in pregnancy” was developed.  Subsequently a manual on “Improving the quality of malaria control services:  A course for health care providers” was also developed.  This manual is used in the region for training.

The centre, working with KNVC (Netherlands) developed QUOTE (guidelines on quality through the eyes of the patient).  A tool was subsequently developed to assess quality of TB control services based on QUOTE.  A short course on “improving the quality of TB prevention and control services in Africa” was developed.  It provides a comprehensive training package for operational personnel at health facility level.

Building regional capacity through training:  The centre has developed a wide range of short courses which it can offer.  These courses last one to two weeks.  The courses are on QOC, logistics, QA, facilitative supervision, IT, costing, Foundations of innovative training, Operations research, Economic evaluation, Malaria update, Nutrition update, and maternal health update.

The post-graduate diploma in QOC is offered for one year.  It requires 3 months reading and nine months of work study in students’ place of work under supervision of a University affiliated mentor.  The post-graduate diploma will be revised to focus on more practical aspects of QOC while a masters degree in QOC is being developed.  The countries that have benefited most are Uganda, Zambia, Tanzania, Kenya, Malawi, Lesotho and Ethiopia.  Other countries that benefited include Zimbabwe, South Africa, Swaziland, Rwanda, Namibia, Mozambique, Madagascar, Eritrea, Burundi and Botswana.

 
Operationalising better practices through research
The center uses operational and other research methods to develop programmes, manuals, guidelines and policy briefs.  Some of the studies have been published for international and professional audience.  But most importantly the materials have been adopted and are in use by organizations, districts and ministries of health.  They include:

In 2000 QoC study in Family Planning was done.  It led to the setting up of the Yellow Program in Uganda, a program to improve quality.

From 2000-2002, a study was done to assess barriers to effective anaemia prevention interventions.  The barriers found included inadequate logistics, under use of ANC services, lack of awareness.  The results of the study were used to develop a manual for anaemia prevention among pregnant women.

In 2000 and 2003 WHO sponsored a study to validate HIV algorithm in identifying symptomatic HIV infection in children.  The study was used to modify IMCI manuals in the country.

RCQHC carried out study on home-based HIV/AIDS care programmes in Uganda.  The results were used to improve programme design and implementation.

Through a study by RCQHC, anaemia was found to be rampant among pregnant and lactating mothers.  The study led to the formulation of a minimum package for anaemia prevention and management through PIA.

In 2002 the centre carried out an RH survey which led to the publication of a paper on the possibilities of RH NGOs to engage in health swap.

In 2002 a study on provider perspectives on FP QOC was done.  This led to a policy brief developed by WHO.

In 2003, the centre with the Population Council carried out operational research training for RH managers in the region.  The idea was to use operational research for programme management.

In 2004, the study on quality of care from the perspective of the TB patient was initiated.  This led to the development of QUOTE tools and guidelines for management of TB services.

In 2005, a multi-country and donor study carried out at the centre on examining issues of paediatric HIV/AIDS led to the development of paediatric ART programmes for the first time in the region.

In 2006, in collaboration with several partners, the centre carried out an assessment of Active Management of the Third Stage of Labour (AMTSL).  The study found AMTSL use very low in the region and initiated the designing of a programme to address the problem of postpartum haemorrhage through AMTSL.

QOC study in malaria control was carried out.  This led the centre to develop QOC assessment tool, now in use in several countries.

A study done to assess differences in HIV/AILDS care for AIDS among non-AIDS orphans, and non-orphans led to important inputs into Uganda’s Orphans and Vulnerable Children Policy.

RCQHC has been a recognized training institution in Quality Assurance over the years of its existence.
The following short courses were held since year 2000 with the respective number of health workers trained from the region.