Discussion
The lack of local and central registration systems makes it broadly
difficult to track and evaluate the progress and development of QI work
across the Gaza Strip. However, up until 2015, no evidence is available
of any systematic QI work undertaken by medical students or healthcare
practitioners in Gaza Hospitals.
The implementation of measures endorsing audit activities by local
medical schools, MoH and PMC led to a growing awareness of the concepts
of QI work and harnessed the cooperation between healthcare
professionals and medical students to conduct clinical audits. This was
reflected by a steady increase in the number of audits undertaken in
local healthcare practice. An increasing number of abstract submissions
to the international Lancet Palestinian Health Alliance (LPHA) annual
conference was also observed between 2015 to 2018 with some positive
impact reports 16 17.
Crucially, the cycle has to be completed in order to assess the impact
of the original audit. In this study, the cycle was found completed in
only one fifth of all projects (20.9%). This number is low but,
nonetheless, similar to those reported in other studies9 10 1819 20. Although such studies were
undertaken in the context of a well-developed and supported audit
programmes unlike that of this study, efforts should still be made
towards achieving higher completion rates in our local practice and
elsewhere.
Although the observed spike in audit numbers is encouraging, the impact
of audit activities in Gaza is still lagging behind with only seven
studies (11.3%) reporting subsequent improvements in practice. In
general, audits with local staff involvement and senior leadership
proved to be most effective in initiating and leading improvements7 8 9. The
provision of feedback to the local staff through presentation of results
at internal meetings has also been shown to be effective12. Other measures such as the availability of
dedicated support teams or the provision of protected time for QI work5 21 2223 24 are often difficult to
implement in the case of low-income countries 2526. Therefore, it is imperative to focus on factors
that can potentially be supported in such settings in order to produce
QI work with the highest possible impact 2726.