Quality improvement interventions targeting immunization data from urban lower-level private-for-profit health service providers in Kampala Capital City: processes and implementation experiences

Abstract

Background Lower-level private-for-profit urban immunization service providers contribute immensely to service delivery and data generation which informs evidence-based planning for the delivery of equitable immunization services within the urban context. And yet, current efforts tend to over-concentrate on supporting the public health sector. We conducted this implementation research study in a bid to contribute to improvements in the accuracy and timeliness of immunization service data among lower-level private-for-profit immunization service providers within Kampala Capital City of Uganda. Methods A quasi-experimental design was adopted with a participatory process leading to the identification of two poor-performing city divisions where the intervention was implemented. Forty private health facilities participated in the implementation research with 20 assigned to the intervention while the other 20 were assigned to the control. Performance measurements were assessed at baseline and end-line to compare outcomes between the intervention and control groups. Results Through a theory-driven design with the COM-B as the guiding model, the behavioural change intervention functions targeted to cause the desired change leading to improvements in data quality among private providers were; (1) training, (2) modelling, (3) persuasion, (4) education, (5) environmental restructuring, (6) enablement and (7) coercion. In combination, they were primed to contribute to improvements in skills and approaches to data handling while maintaining of a close oversight function. Conclusions The applied intervention components were preferred for their contextual applicability within the urban private immunization service delivery settings with a likelihood of sustaining the gains for some time.