Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh

Hoque, Dewan Md Emdadul; Arifeen, Shams El; Rahman, Mahbubur; Chowdhury, Enayet K.; Haque, Twaha Mansurun; Begum, Kohinoor; Hossain, M. Altaf; Akter, Tasnima; Haque, Fazlul; Anwar, Tariq; Billah, Sk Masum; Rahman, Ahmed Ehsanur; Huque, Hamidul; Christou, Aliki; Baqui, Abdullah H; Bryce, Jennifer; Black, Robert E.

doi:10.1093/heapol/czt059

Cited by 30 publications

(29 citation statements)

References 22 publications

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“…Our findings add to the existing literature 30 – 32 and indicate that supportive supervision can improve both adherence to clinical guidelines and the overall quality of care.…”

Section: Discussionsupporting

confidence: 72%

“…In our study and a study in Kenya, 30 the supportive supervision team comprised paediatricians; of two trials performed in primary care, the providers were paediatricians in one 31 and medical officers and staff supervising the Integrated Management of Childhood Illness in the other 32 . The characteristics of the ideal provider may depend on who is receiving supportive supervision: adequately trained medical officers may be able to provide effective supportive supervision to primary care staff, whereas a team of experienced paediatricians may be needed for hospital staff.…”

Section: Discussionmentioning

confidence: 99%

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Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Lazzerini

Shukurova

Davletbaeva³

et al. 2016

Bull. World Health Organ.

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ObjectiveTo determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.MethodsIn a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.FindingsWe prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.ConclusionPeriodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

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“…Our findings add to the existing literature 30 – 32 and indicate that supportive supervision can improve both adherence to clinical guidelines and the overall quality of care.…”

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Lazzerini

Shukurova

Davletbaeva³

et al. 2016

Bull. World Health Organ.

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show abstract

“…We found that a standard, 4-day, WHO training course followed by periodic supportive supervision from national, trained paediatricians every 2 months for 1 year significantly reduced inappropriate case management of hospitalized children and improved the overall quality of paediatric care. Our findings add to the existing literature [30][31][32] and indicate that supportive supervision can improve both adherence to clinical guidelines and the overall quality of care.…”

Section: Discussionsupporting

confidence: 72%

Improving the quality of hospital care for children by supportive supervision: A cluster randomized trial, Kyrgyzstan

Lazzerini¹,

Shukurova²,

Davletbaeva³

et al. 2017

WIDER Working Paper

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Objective To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low. Methods In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care. Findings We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals. Conclusion Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

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“…Randomized trial evidence has shown positive effects of supervision on care for children under-5 using IMCI (Hoque et al 2014, Pariyo et al 2005b, Kayemba Nalwadda et al 2013, Amaral et al 2004) for general primary care (including vaccination, vitamin A distribution, family planning, antenatal care, and costs per capita) (Loevinsohn et al 1995) and primary eye care (Okwen et al 2014). Plausibility trial evidence also supports the association of increased or enhanced supervision with quality of immunization services (Djibuti et al 2009), STI services (Mugala et al 2010), malaria care and treatment (Zurovac et al 2004), management of childhood diarrhoea (Pham DM et al 2013), and correct use of pharmaceuticals from front-line dispensaries (Ross-Degnan D et al 2007).…”

Section: Resultsmentioning

confidence: 99%

Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods

Vasan

Mabey

Chaudhri

et al. 2016

Health Policy Plan.

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Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.

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Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh

Cited by 30 publications

References 22 publications

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Improving the quality of hospital care for children by supportive supervision: A cluster randomized trial, Kyrgyzstan

Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods

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