Using Practical Quality Improvement Approaches and Tools in Reproductive Health Services in East Africa

Dohlie, Maj-Britt; Mielke, Erin; Mumba, Feddis; Wambwa, G; Rukonge, Anatole; Mongo, Wilfred

doi:10.1016/s1070-3241(16)30471-0

Cited by 10 publications

(5 citation statements)

References 2 publications

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“…In the UWR, management at the various districts and at the regional levels remained responsible for planning and implementation of work, making available the facilities, training, and other resources needed to achieve their targets. To those who argue that the facilitative approach will be resource-intensive, some activities in East Africa have shown that the approach is possible even in very resource-poor settings [14]. …”

Section: Discussionmentioning

confidence: 99%

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana

Aikins

Laar

Nonvignon

et al. 2013

BMC Health Serv Res

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BackgroundIn Ghana’s health delivery services, facilitative supervisory visit (FSV) as a system of management is new. This paper presents the standard evaluation results of FSV, which formed an integral part of the community-based health planning services (CHPS) initiative.MethodsThe study was conducted in the Upper West Region of Ghana. The Project developed guidelines and tools for FSV for four different health system levels – regional, district, sub-district and community levels. Electronic data from all four levels representing quarterly results were compiled into their annual equivalents, and summarized graphically for comparison.ResultsThe data show that all the nine districts embraced the FSV concept even though they differed markedly with regard to the degree of adherence to some set benchmarks. Three DHMTs (Wa Municipal, Lawra and Jirapa) were graded as good while the remaining six DHMTs were adjudged as fair in relation to management of supplies, transport and equipment, information, meeting, and technical support.ConclusionsThe data further suggest that there is much to gain both individually and institutionally from FSVs. Generally, FSVs are crucial to the delivery of primary health care services in especially rural areas.

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Section: Discussionmentioning

confidence: 99%

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana

Aikins

Laar

Nonvignon

et al. 2013

BMC Health Serv Res

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“…Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions Introduction Quality improvement (QI) Á sometimes also referred to as quality assurance (QA) Á is the process of continuously assessing and improving the quality of goods or services to ensure client satisfaction and loyalty (Taegtmeyer & Doyle, 2003). The concept of QI was initially conducted in industrial and commercial sectors and has been since successfully adapted in community health, reproductive health, and counseling services (Dohlie et al, 1999, Steenbarger & Smith, 1996, sometime with different approaches and appellations by different organizations (The ACQUIRE Project/EngenderHealth, 2005). However, QI has not been applied widely or documented in HIV prevention research, including clinical trials.…”

Section: Ensuring Quality Of Services In Hiv Prevention Research Settmentioning

confidence: 99%

Ensuring quality of services in HIV prevention research settings: findings from a multi-center quality improvement pilot in East Africa

et al. 2009

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Quality improvement (QI) has been widely implemented in health services but has not been widely applied in HIV prevention research. Most prevention research centers have commonly employed traditional approaches (e.g., checklists) to quality control that document what has been done but not the quality of what has been done. Unlike other health settings, prevention research settings have unique characteristics and ethical requirements that require the development or adaptation of specific quality indicators. A QI model for health services was adapted for use in prevention research settings and was piloted between August 2006 and July 2007 at three research centers in East Africa. Four hundred and twenty-six volunteers exit interviews were administered in two cycles. Quantitative and qualitative data were analyzed using Excel worksheets. QI meeting reports and QI plans were used to complement data from exit interviews. On average, 52% of total enrolled volunteers participated in the exit interview. The designed QI plans successfully helped reduce volunteers' reported waiting time to see counselors (p<0.001) and pharmacists (p<0.001). It also increased the percentage of interviewed volunteers who reported being counseled on family planning at clinical trials (from 66 to 93%; p=0.02) at follow-up visits, and who were refreshed on informed consent at follow-up visits (from 90 to 96%; p=0.009). The percentage of interviewed volunteers that expressed satisfaction with services received from counselors increased (from 87 to 94%; p=0.009) while the percentage of volunteer satisfied with services from trial physicians remained constant (93%). The majority of volunteers interviewed reported satisfaction with other major components of research such as confidentiality, understanding of trial objectives, benefits and risks of participation, and risk reduction counseling. However, satisfaction with services from community outreach workers and other staff at research centers dropped over the course of the study (from 88% in Cycle 1 to 74% in Cycle 3; p= < 0.001). Increased commitment to QI is crucial in ensuring quality of services and ethical conduct of HIV prevention research centers.

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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.…”

mentioning

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.…”

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

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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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Using Practical Quality Improvement Approaches and Tools in Reproductive Health Services in East Africa

Cited by 10 publications

References 2 publications

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana

Ensuring quality of services in HIV prevention research settings: findings from a multi-center quality improvement pilot in East Africa

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

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