This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.

The joint BASICS/Quality Assurance Project tested several research-based interventions in three districts in Niger, West Africa to improve case management of sick children. The research design was a non-concurrent, prospective case control design. Quality of care was determined as the degree of compliance of health care workers with the Integrated Management of Childhood Illness (IMCI) standards of assessment, treatment and counselling of sick children and their caretakers. The interventions tested were (1) structured feedback of health worker performance data and (2) formal IMCI training and (3) team-based quality improvement. Performance feedback had a significant effect on compliance. Performance feedback alone created a significant short-term impact on health care worker compliance, which improved between 34% and 85% in areas of assessment of sick children (p < 0.05). In addition, performance feedback was significantly cheaper than formal training ($108 per health worker versus $430 per worker for IMCI training). However, this impact was not universal over all areas of compliance following each feedback. Instead, performance feedback had the greatest effect in areas in which health care workers performed poorly, while areas in which compliance was high eventually saw declines. In settings such as Niger, which has the highest child mortality in the world according to UNICEF figures, low-cost techniques for supporting health workers once they have been trained in clinical standards are sorely needed. Performance feedback shows promise as a technique for improving quality of care with clinical algorithms such as IMCI.

Despite appropriate guidelines, healthcare services worldwide often fail to deliver high-impact evidence-based care. This case study describes a large-scale programme to improve integrated postpartum care for mothers and newborns in Niger and Mali. As a result of an improvement effort based on common objectives, local ownership and shared learning to accelerate implementation of best practices, 78 facilities demonstrated rapid improvement in compliance with standards for post-partum haemorrhage prevention and Essential Newborn Care as well as a reduction in estimated postpartum haemorrhage. This approach yields rapid results and can be efficiently spread to improve care in low-resource settings.

Behavior change communication theory and qualitative research can be applied to the design of key messages on adherence to an antibiotic regimen and corresponding job aids for both parents and health care workers. This approach generates enthusiastic support from local participants.

Recognizing the notable scale of USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project activities and sizable number of improvement teams, which in some cases is close to 1,000 improvement teams managed in one country at a point in time, we sought to answer the questions: How do we manage hundreds of improvement teams in one country alone? How do we manage more than 4,000 improvement teams globally? The leaders of our improvement programs manage such efforts as though they are second-nature, without pointing to the specific skills and strategies needed to manage thousands of teams. This paper was developed to capture the lessons, considerations, and insights shared in discussions with leaders on the USAID ASSIST Project, including country Chiefs of Party and Regional Directors. More specifically, this paper seeks to describe what is involved in scaling up and managing large numbers of improvement teams. Through focus group discussions and individual interviews, participants discussed the key skills, strategies, and lessons needed to successfully manage large numbers of teams on the USAID ASSIST Project. We concluded that the six key components in managing large numbers of teams are 1) leadership; 2) management structures and capacities; 3) clear and open communication; 4) shared learning, collaboration, and support; 5) ownership, engagement, and empowerment; and 6) partnerships. We further analyzed these six components as being interrelated to one another based on the relationship between culture, strategy, and technique in implementing quality improvement activities.