Building a Culture of Learning: Lessons from Expanding HIV Treatment in Mozambique

HIV is a leading cause of death in Mozambique, which experiences stresses to its under-resourced health system. In 2020, the Ministry of Health expanded eligibility criteria to enable more people living with HIV to enroll in quarterly HIV treatment distribution, meaning they would spend less time in overcrowded health facilities at the height of the pandemic. Though the program saw initial gains, three-month drug dispensation (3MDD) enrollment plateaued. The USAID-funded Efficiencies for Clinical HIV Outcomes (ECHO) project leveraged its organizational culture of learning to uncover reasons for this enrollment plateau and bring patients into the program.

With a dedicated Innovation, Learning, and Adapting (ILA) team integrated into senior leadership, the ECHO project’s structure facilitates collaborating, learning, and collabor(CLA). Events ranging from innovation competitions to weekly data discussions reinforce a foundation of learning that empowers staff at all levels to question the status quo and seek creative solutions to challenges. When the project confronted low 3MDD enrollment, ILA, technical, and stakeholder teams assembled in Manica province to break down siloes and brainstorm new interventions. The team found it necessary to connect the dots between activities occurring in isolation. As a group, teams reworked its research exploring the reasons behind 3MDD decline. Monitoring teams looked at patient data closely, shared visualizations with stakeholders, and facilitated conversations to understand what counselors, health providers, and pharmacists envisioned as realistic solutions. Through these CLA initiatives, the ECHO project team moved the needle on 3MDD enrollment. It also uncovered pitfalls when ILA teams operate in a silo. Responding to the team’s research, the project shifted its approach to CLA and broadened its culture of learning across provinces, teams, and stakeholders. As a result, ECHO's foundation of CLA is stronger and will pass more effectively to our partners.