Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger

Legros, Stephane; Tawfik, Y; Abdallah, H; Crespin, Xavier; Djingarey, Mamoudou Harouna; Catsambas, Tessie Tzavaras

doi:10.1093/intqhc/14.suppl_1.97

Cited by 11 publications

(5 citation statements)

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“…Although management has been recognized as fundamental to health worker performance and motivation, [14][15][16] peer-reviewed studies on management, including quality improvement efforts, in global health are limited in their size, scope, and rigor. About 2 dozen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] including a literature review 38 have examined the link between management and health system performance in low-and middle-income settings in the last 20 years. These studies are largely uniform in their findings, demonstrating that interventions to build management capacity in facilities and district health teams can influence performance.…”

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confidence: 99%

“…For instance, one study 21 shows improvements in tuberculosis (TB) case detection rates, patient adherence to TB medication regimens, specimen quality, supply stock outs and timely deliveries. Other studies have documented 22,28,[32][33][34][35] improvements in live birth registrations, percentage of fully immunized children, improved medical records, enhanced infection prevention procedures, clinical guideline adherence, and reduced emergency room and cardiac catheterization waiting time. Although this research is helpful, most studies include data related only to a single organization or district and employ pre-post interventional designs without a comparison to nonintervention sites, with limited statistical analysis.…”

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confidence: 99%

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Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Bradley

Taylor

Cuellar

2015

Int J Health Policy Manag

101

123

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Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management -defined here as the process of achieving predetermined objectives through human, financial, and technical resources -is a cross-cutting function necessary for success in all World Health Organization (WHO) building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved methodological rigor and longer-time horizon investigations. Meanwhile, greater emphasis on management as a critical element of global health efforts may open new and sustainable avenues for advancing health systems performance.

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confidence: 99%

mentioning

confidence: 99%

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Bradley

Taylor

Cuellar

2015

Int J Health Policy Manag

101

123

View full text Add to dashboard Cite

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“…In addition to the community‐level intervention that targeted service demand, the project team and government partners engaged a quality improvement expert to conceive the strategy for strengthening ANC services by IHCs and to address supply‐side constraints. The approach built on successful methodologies applied elsewhere in Niger and neighbouring countries (Legros et al, ). The ANC staff of the 12 targeted IHC were grouped into three quality improvement teams.…”

Section: Resultsmentioning

confidence: 99%

“…The approach built on successful methodologies applied elsewhere in Niger and neighbouring countries (Legros et al, 2002). The ANC staff of the 12 targeted IHC were grouped into three quality improvement teams.…”

Section: Quality Improvement Approachmentioning

confidence: 99%

Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger

Hess

Ouédraogo

Bamba

et al. 2017

Maternal & Child Nutrition

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In Niger, use of antenatal care (ANC) and iron folic acid (IFA) supplements is suboptimal. The objectives of this paper are as follows: (a) to conduct formative research to understand barriers and beliefs among pregnant women related to ANC, IFA supplementation, and pregnancy outcomes; (b) assess the quality of currently provided ANC services; (c) use the findings to guide the development of programmatic interventions to improve coverage of ANC services and IFA supplementation of pregnant women. Structured in-home interviews (n = 72) and focus groups (n = 4) were conducted with pregnant women in 4 randomly selected villages in rural Zinder. ANC consultations (n = 33) were observed in 5 randomly selected health centres, and exit interviews were conducted with all pregnant women and seven health agents following these observations. During workshops with stakeholders, results of the formative research were interpreted, and programmatic interventions were developed. In home interviews, 72% of women reported having attended at least one ANC visit. They also reported husbands (71%), mothers (40%), and friends (33%) supporting ANC attendance. Among those having attended ANC, only 65% reported taking IFA the day prior to the interview. Three of five health centres visited had IFA in stock. Health staff did not provide IFA supplements during 18 of 33 observed ANC consultations of which only 7 cases could be explained by the lack of IFA supplements in stock. Findings were used to design a 3-pronged intervention: (a) behaviour change communication activities in communities; (b) quality improvement activities in health centres to strengthen ANC; and (c) provision of key supplies required for ANC.

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“…The implemented QI activities adopted a modified strategy of a previous quality assurance project conducted in Niger from 1993 to 1997, relying on formative supervision and coaching of key IHC personnel 28. Prior to the implementation of the programmatic intervention, a second programme impact pathway was developed for the health-centre level interventions (online supplementary figure 2).…”

Section: Methodsmentioning

confidence: 99%

The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger

et al. 2019

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BackgroundAnaemia is prevalent among pregnant women in rural Niger and antenatal care (ANC) attendance is suboptimal. We designed a programmatic intervention including community-based behaviour change communication, provision of essential drugs (including iron folic acid (IFA) supplements) and quality improvement activities at selected integrated health centres (IHCs).ObjectiveTo assess the impact of the programmatic intervention on: (1) utilisation of ANC, (2) adherence to daily IFA supplementation and (3) prevalence of adequate gestational weight gain (GWG) and anaemia among pregnant women in Zinder, Niger.MethodsUsing a quasi-experimental study design comparing a cohort of women at baseline to another cohort of women at endline, 18 IHCs and surrounding villages were randomly assigned to time of enrolment over 1 year. A baseline survey was implemented among randomly selected pregnant women in 68 village clusters. Subsequently, the intervention was rolled out and an endline survey was implemented 6 months later in the same villages.ResultsMean age in the baseline (n=1385) and endline (n=922) surveys was 25.8±6.4 years. The percentage of pregnant women who reported attending any number of ANC and an adequate number of ANC for their gestational age, respectively, was not significantly different between the endline and the baseline surveys. Pregnant women in the endline survey were more likely to have received IFA (60.0% vs 45.8%, OR: 2.7 (1.2, 6.1)); and the proportion of pregnant women who reportedly consumed IFA daily in the previous 7 days was significantly higher in the endline than in the baseline survey (46.4% vs 32.8%, OR: 2.8 (1.2, 6.5)). There was no impact on the prevalence of adequate GWG or anaemia.ConclusionsThe programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving and consuming IFA supplements as recommended, but did not affect ANC attendance and nutritional status.

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Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger

Abstract: Several factors contributed to the success of the Tahoua QA program and the joint project: teamwork, focus on patients, clarity of roles through standards, and synergy between the QA Project and the BASICS Project.

Cited by 11 publications

References 1 publication

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger

The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger

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