A presentation by Robinson Karuga on quality improvement in community health worker programmes in Kenya. This was given at the 2016 Global Symposium on Health Systems Research.
34-63% of counties have maternal health tracer drugs but 18-39% of child health tracer drugs available
Large disparities in the availability of first line HIV drugs (0-50%)
Kisumu, Kisii, Vihiga, and Siaya consistently top third in drug availability
Transzoia, E-Marakwet, Nandi, Nyeri & T.River bottom
11 maternal health tracer drugs
11 child health tracer drugs
First-line drugs for HIV
ACT, first line treatment for malaria
4FDC, intensive treatment for tuberculosis
Metformin, preferred OGLA treatment for diabetes
Linking structural challenges with best practice in water governance: Understanding cultural norms in institutionalized corruption
Presented by Diana Suhardiman at the 2016 Stockholm World Water Week, in Stockholm, Sweden, on August 31, 2016.
Seminar: Good water governance for inclusive growth and poverty reduction: Session 2 on successful case studies of good water governance
Health systems in post-conflict states - Learning from the ReBUILD programmeReBUILD for Resilience
Presentation given by Joanna Raven on ReBUILD's work on health systems in post-conflict states, at a Workshop on Rebuilding Health in Yemen after Conflict, 4th June 2016 in Liverpool
Neha Kumar
POLICY SEMINAR
Examining the State of Community-led Development Programming
Co-Organized by IFPRI and Movement for Community-led Development
APR 7, 2021 - 09:30 AM TO 11:00 AM EDT
34-63% of counties have maternal health tracer drugs but 18-39% of child health tracer drugs available
Large disparities in the availability of first line HIV drugs (0-50%)
Kisumu, Kisii, Vihiga, and Siaya consistently top third in drug availability
Transzoia, E-Marakwet, Nandi, Nyeri & T.River bottom
11 maternal health tracer drugs
11 child health tracer drugs
First-line drugs for HIV
ACT, first line treatment for malaria
4FDC, intensive treatment for tuberculosis
Metformin, preferred OGLA treatment for diabetes
Linking structural challenges with best practice in water governance: Understanding cultural norms in institutionalized corruption
Presented by Diana Suhardiman at the 2016 Stockholm World Water Week, in Stockholm, Sweden, on August 31, 2016.
Seminar: Good water governance for inclusive growth and poverty reduction: Session 2 on successful case studies of good water governance
Health systems in post-conflict states - Learning from the ReBUILD programmeReBUILD for Resilience
Presentation given by Joanna Raven on ReBUILD's work on health systems in post-conflict states, at a Workshop on Rebuilding Health in Yemen after Conflict, 4th June 2016 in Liverpool
Neha Kumar
POLICY SEMINAR
Examining the State of Community-led Development Programming
Co-Organized by IFPRI and Movement for Community-led Development
APR 7, 2021 - 09:30 AM TO 11:00 AM EDT
Gender indicators for women’s empowerment strategies in water and food securi...Global Water Partnership
Presentation made by Dr Alice M. Bouman-Dentener , President of the Woman for Water Partnership, World Water Week, August 26-31, 2012, Stockholm, Sweden
Key findings, lessons learned and next steps for TrackFinTrackFin
This presentation was made during the TrackFin Intercountry Workshop in Rabat on 28-29th September 2014. It summarises the key finding and lessons learned from developing WASH-Accounts in the 3 countries (Brazil, Ghana and Morocco). It makes recommendations for the way forward, from the short to the longer term.
HPRP can be combined with other resources to create a set of prevention initiatives that is coordinated and strategically designed to stop high risk groups from becoming homeless. This workshop will examine how communities with a coordinated prevention strategy target resources, identify and address service gaps, avoid duplication, and measure outcomes.
Human Resources in Fragile and Conflict-Affected settings - cross sectoral is...ReBUILD for Resilience
Overview presentation by Tim Martineau for seminar on human resources in health and education in fragile and conflict affected settings, organised by HEART in June 2016.
This presentation provides insight on how to drive health equity into action at a community level.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Gender indicators for women’s empowerment strategies in water and food securi...Global Water Partnership
Presentation made by Dr Alice M. Bouman-Dentener , President of the Woman for Water Partnership, World Water Week, August 26-31, 2012, Stockholm, Sweden
Key findings, lessons learned and next steps for TrackFinTrackFin
This presentation was made during the TrackFin Intercountry Workshop in Rabat on 28-29th September 2014. It summarises the key finding and lessons learned from developing WASH-Accounts in the 3 countries (Brazil, Ghana and Morocco). It makes recommendations for the way forward, from the short to the longer term.
HPRP can be combined with other resources to create a set of prevention initiatives that is coordinated and strategically designed to stop high risk groups from becoming homeless. This workshop will examine how communities with a coordinated prevention strategy target resources, identify and address service gaps, avoid duplication, and measure outcomes.
Human Resources in Fragile and Conflict-Affected settings - cross sectoral is...ReBUILD for Resilience
Overview presentation by Tim Martineau for seminar on human resources in health and education in fragile and conflict affected settings, organised by HEART in June 2016.
This presentation provides insight on how to drive health equity into action at a community level.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Overview:
Overview of health workforce in Africa: Numbers and beyond
Causes of crisis and solutions
Financing the health workforce
Global attention
You can help
Dennis Dunmyer, BBA, MSW, JD, Vice President of Behavioral Health and Community Programs, Kansas City CARE Clinic
Learning Objectives:
1. Explore the approach to Missouri’s Community Health Worker workforce.
2. Discuss the role of school-based health care in preventative medicine.
3. Discuss examples of workplace wellness programs that create healthier employees while improving an organization’s bottom line.
Presentation delivered at the MerchantMedicine Conference on Urgent Care focusing on the evolution of primary care. Presentation explores how payers are using market forces to benefit providers who deliver high-value care and the economic impact generated for risk-owners from high-value providers.
Health Equity into Action: Building on Partnerships and CollaborationsWellesley Institute
This presentation offers insight on how to put health equity into action by building on partnerships and collaborations.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
KEYSTONE HPSR Initiative // Module 6: Policy Analysis // Slideshow 3: Researching Health Policy
This is the third slideshow of Module 6: Policy Analysis, of the KEYSTONE Teaching and Learning Resources for Health Policy and Systems Research
To access video sessions and slides for all modules copy and past the following link in your browser:
http://bit.ly/25vVVp1
Module 6: Policy analysis
This module focuses on the policy analysis approach to understand who makes policy decisions (power) and how and why these decisions are made (process). As a field primarily preoccupied with understanding decision-making, contemporary policy analysis approaches place actors at the heart of systems, problematize policy content, are attentive to context, and can see implementation as a series of social relationships rather than as an obvious consequence of policymaking.
There are 5 slideshows in this module.
Module 6: Policy analysis
-Module 6 Slideshow 1: Introducing Health Policy
-Module 6 Slideshow 2: Policy Approach & Frameworks
-Module 6 Slideshow 3: Researching Health Policy
-Module 6 Slideshow 4: Group work
-Module 6 Slideshow 5: Group work
The other modules in this series are:
Module 1: Introducing Health Systems & Health Policy
Module 2: Social justice, equity & gender
Module 3: System complexity
Module 4: Health Policy and Systems Research frameworks
Module 5: Economic analysis
Module 7: Realist evaluation
Module 8: Systems thinking
Module 9: Ethnography
Module 10: Implementation research
Module 11: Participatory action research
Module 12: Knowledge translation
Module 13: Research Plan Writing
KEYSTONE is a collective initiative of several Indian health policy and systems research (HPSR) organizations to strengthen national capacity in HPSR towards addressing critical needs of health systems and policy development. KEYSTONE is convened by the Public Health Foundation of India in its role as Nodal Institute of the Alliance for Health Policy and Systems Research (AHPSR).
The inaugural KEYSTONE short course was conducted in New Delhi from 23 February – 5 March 2015. In the process of delivering the inaugural course, a suite of teaching and learning materials were developed under Creative Commons license, and are being made available as open access resources. The KEYSTONE teaching and learning resources include 38 videos and 32 slide presentations organized into 13 modules. These materials cover foundational concepts, common approaches used in HPSR, and guidance for preparing a research plan.
These resources were created and are made available through support and funding from the Alliance for Health Policy & Systems Research (AHPSR), WHO for the KEYSTONE initiative
Reply 1The health care system began from the local level and was.docxcarlt4
Reply 1
The health care system began from the local level and was provided to the general population. Understanding the health care system at the local level is very important while considering the implementation of evidence-based practice because it requires various resources like workforce, financial assistance, and collaboration with other stakeholders. When we implement EBP, it is crucial to have well-trained, skilled health care professionals such as doctors, nurses, and another multidisciplinary team to have an effective result. This is the long run, will assist in promoting the significance of using evidence-based practice. Another critical factor is understanding the culture of the healthcare system for planning and implementing EBP and understanding the leadership of the local health care system. In their study, Klein et al. (2017) discuss how important it was to understand their local healthcare system. The city council of Stockton attempted to combat childhood obesity by forcing restaurants serving children's meals to serve water or low-fat milk as the default beverage rather than soda or chocolate milk. The public health agency also provides financial incentives to neighborhood retailers to sell vegetables from the region's many farms.
For my change project on patient safety, since it involves the transition of care from inpatient to outpatient and partial hospitalization programs, I would consider involving families, local communities, and other healthcare agencies. Because nurses like to get knowledge from their peers and via social contacts, having a core group in conjunction with change champions can aid with practice change implementation. A core group is a small group of practitioners who share the purpose of distributing knowledge about a practice change and assisting other unit members in making the change. Another critical factor to consider is that individuals do not abuse their freedom and violate established boundaries, particularly those that control people's health, safety, and cultural beliefs.
Reference
Klein. S, Hosteller. M and McCarthy. D (2017),
All Health Care Is Local, Revisited: What Does It Take to Improve
.
https://www.commonwealthfund.org/publications/other-publication/2017/sep/all-health-care-local-revisited-what-does-it-take-
Reply 2
3 posts
Re: Topic 4 DQ 1
Before implementing any changes locally based on Evidence-Based Practice (EBP), it is essential to consider what resources are available locally. Effective understanding of healthcare system at the local level is essential in planning the implementation of Evidence-Based Practice (EBP) model for various reasons. Firstly, the implementation of EBP needs different resources at these levels. These include enough human capital and monetary funding. Skilled human capital is essential since it provides expertise and leadership necessary in implementing EBP (Warren et al., 2016). Implementing EBP requires skilled nurses, physicians, and other he.
Pre-summit workshop on Wedesday, April 10 at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Learn more about quality improvement from the perspectives and experiences of Canada’s senior health care leaders. Recently, the Health Council of Canada interviewed these leaders and surveyed governments about their quality improvement efforts across federal, provincial and territorial health care systems. This presentation provides insight into the wide range of system-level quality improvement approaches across the country as well as the success factors and barriers to change. It also provides an overview of the many innovative quality improvement initiatives taking place across the country.
Person-Centred Care, Equity and Other Building Blocks For Excellent Care For AllWellesley Institute
This presentation examines the building blocks for excellent care.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
The legislature and the administration will be revisiting portions of the approved two-year state budget this spring.
This “mid-biennium” budget review is sure to mean policy changes that affect health, human services, and early care & education in Ohio.
This presentation examines the ways in which local action can achieve health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
EOA2016: Accelerating the Triple Aim through Innovations in MedicaidPIHCSnohomish
During the 3rd breakout session at Edge of Amazing, a panel came together to discuss the State's Medicaid program. Leading the nation in innovations to improve the health of some of our state's most vulnerable populations. This session provided an overview of initiative envisioned under the Medicaid Transformation Waiver and featured efforts of the North Sound ACH.
John Brumbach, Health Care Authority
Karen Fitzharris, Dept of Social and Health Services
Kali Klein, Health Care Authority
Dean Wight, Whatcom Alliance for Health Advancement
2015 - HCBS National Conference
Panel Presentation on how three states are leveraging the benefits of MLTSS to meet the needs of individuals receiving home and community based services through Medicaid.
Importance of Community Health Strategy (CHS) in attaining health goals (MNCH...REACHOUTCONSORTIUMSLIDES
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by S. N. Njoroge on behalf of the Kenyan Ministry of Health. http://usaidsqale.reachoutconsortium.org/
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Prisca Muange on behalf of USAID Assist. http://usaidsqale.reachoutconsortium.org/
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Florence Achungo on behalf of Westlands Sub-County. http://usaidsqale.reachoutconsortium.org/
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Mito on behalf of MEASURE Evaluation PIMA. http://usaidsqale.reachoutconsortium.org/
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Kandie on behalf of the Ministry of Health (Kenya). http://usaidsqale.reachoutconsortium.org/
Sustaining quality approaches for locally embedded community health services ...REACHOUTCONSORTIUMSLIDES
This presentation was given at the Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services Symposium which was held in September 2016
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Embedding Quality Improvement in devolved health settings
1. Learning to embed quality improvement
approaches at community level in Kenya’s devolved
health system
Robinson Karuga
Research Fellow
LVCT Health
1
.
3. Challenges in Devolving Health
3
www.lvcthealth.org
Low budgetary allocations
Varying Prioritization of Health
Human resource challenges
Attitudes of Officials
Delayed financial disbursements
Source: http://gadocartoons.com/the-only-county-devolution-has-not-happened-yet/ Source: Health Policy Project (2015)
4. Political Process of Embedding QI
in Devolved Setting
Process Actors
ContextContent
• Understand National vs County
Roles
• Understand power dynamics
• Align QI to National & County
Priorities
• Consider interests at each level
• Simplify!
• Understand pre-existing QI
structures
• Map other key QI actors
• Ensure full consultation
• Consider ALL Interests &
Priorities
• Institutionalize QI at all levels
Editor's Notes
Kenya has been in transition since 2010, after a new constitution was Promulgated. The key pillar of the constitution was division of power and introduction of new levels of government.
A transitional authority was set up between 2011-2013 to prepare the ground for devolution.
The new constitution took effect after the 2013 General Elections. We are learning key lessons on how to manage health in a devolved system.
A. VARYING PRIORITIZATION OF HEALTH
Different counties prioritize health differently at 2 levels:
Political level:
1. Some political leaders at county level perceive health as an expense rather than an investment and hence cut back on county budget proposals in the Assemblies. There is more interest in infrastructural projects for political purposes
2: Some officials in the health departments do not view preventive / promotive health services at community level as primary. They are therefore largely left for NGOs to support
B: LOW BUDGETARY ALLOCATION FOR HEALTH
Most counties do not invest sufficient funding for health – especially community health. Support is left to NGO partners
C: HUMAN RESOURCE CHALLENGES:
Counties inherited a health workforce that existed before devolution and are expected to continue managing this resource. Most counties are in conflict with health workers since they froze recruitment, promotions and other staff benefits. This has created an environment that is not conducive for many health workers leading to industrial actions (strikes and go-slows), demotivated staff, high staff attrition
D: ATTITUDES OF OFFICIALS:
A number of county officials tend to be territorial about work that happens in their jurisdictions and hence frustrate processes that involve officials from the national MoH.
The process of embedding QI can be structured using the Walt-Gilson Policy Process Model that helps us give an in-depth look at the Process, Actors, Content and Context
PROCESS
Its important to ensure that all relevant stakeholders – both government and non-government – are involved in from the beginning of the process
Every stakeholder has an interest and they will need to see how the embedding QI will support them in achieving them
For sustainability, its key to formally institutionalize acceptable structures for QI that are aligned to the health system to ensure continuity
ACTORS
The national and county level government actors have clearly defined roles. Remember to ensure their roles are not conflated whilst embedding QI.
Power to implement health services is now at county level and that’s where to focus efforts to ensure success. National MoH roles are confined to Policy formulation, capacity building, guidelines and technical support / assistance
CONTENT
Ensure that QI content is aligned to National and County priorities. Eg MoH national level are interested in development of a QI manual while counties are keen to have content that guides implementation of QI approaches
All content needs to be simplified to facilitate understanding for actors with low levels of literacy
CONTEXT
While developing structures for QI, ensure that one understands the roles of any existing structures for leverage and avoiding redundancy of structures
It is helpful to map any other actors in QI to synergize and complement QI efforts