scholarly journals A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda

2019 ◽  
Vol 3 ◽  
pp. 1481
Author(s):  
Christine Kim ◽  
Ramadhan Kirunda ◽  
Frederick Mubiru ◽  
Nilufar Rakhmanova ◽  
Leigh Wynne
Keyword(s):  
Quality Improvement ◽  
Family Planning ◽  
Process Evaluation ◽  
Health Workers ◽  
Scale Up ◽  
Data Interpretation ◽  
Quality Improvement Collaborative ◽  
Community Based ◽  
Village Health Team ◽  
Facility Level

Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.

scholarly journals A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda

2019 ◽  
Vol 3 ◽  
pp. 1481
Author(s):  
Christine Kim ◽  
Ramadhan Kirunda ◽  
Frederick Mubiru ◽  
Nilufar Rakhmanova ◽  
Leigh Wynne
Keyword(s):  
Quality Improvement ◽  
Family Planning ◽  
Process Evaluation ◽  
Health Workers ◽  
Scale Up ◽  
Data Interpretation ◽  
Quality Improvement Collaborative ◽  
Community Based ◽  
Village Health Team ◽  
Facility Level

Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.

scholarly journals How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation

2021 ◽  
Vol 10 (2) ◽  
pp. e001147
Author(s):  
Lenore de la Perrelle ◽  
Monica Cations ◽  
Gaery Barbery ◽  
Gorjana Radisic ◽  
Billingsley Kaambwa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Reflective Practice ◽  
Process Evaluation ◽  
Aged Care ◽  
Dementia Care ◽  
Quality Improvement Collaborative ◽  
Programme Theory ◽  
Post Intervention ◽  
Knowledge And Skills ◽  
People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.

scholarly journals Evaluation of a pilot program for task sharing short and long-acting contraceptive methods in Burkina Faso

2020 ◽  
Vol 3 ◽  
pp. 1499
Author(s):  
Dawn S. Chin-Quee ◽  
Kathleen Ridgeway ◽  
Yentéma Onadja ◽  
Georges Guiella ◽  
Guy Martial Bai ◽  
...  
Keyword(s):  
Family Planning ◽  
Burkina Faso ◽  
Health Workers ◽  
Scale Up ◽  
Family Health ◽  
Pilot Project ◽  
Steady Increase ◽  
Task Sharing ◽  
Planning Methods ◽  
Long Acting

Background: The Family Health Directorate of the Ministry of Health  and Marie Stopes Burkina Faso, with implementing partners, Association Burkinabè pour le Bien-être Familial  and Equilibres & Populations  collaboratively conducted a pilot project in Burkina Faso focused on “increasing access to family planning (FP) services through task-sharing short- and long-acting family planning methods to primary care cadres.” Four cadres of providers  provided intrauterine devices (IUDs) and implants, while community health workers (CHWs)  provided pills and subcutaneous injectables. FHI 360 and the Institut Supérieur des Sciences de la Population  evaluated the project’s impact on method uptake, client satisfaction, safety, acceptability and the feasibility of task sharing. Methods: The evaluation employed FP service statistics on new users and conducted 425 client exit interviews  and 27 in-depth interviews . New FP clients, community representatives, MoH officials, and pilot project-trained FP providers from Dandé and Tougan districts participated in these interviews. Results: Providers, community representatives and government officials all spoke favorably of the pilot project and considered it a boon to women and the communities in which they lived. FP clients were satisfied with their methods and the services they received from their respective providers, and they reported no safety concerns. However, service statistics did not show a clear and steady increase in method uptake for the four methods beyond spikes coinciding with pre-existing free contraceptive weeks. Conclusions:  A scale-up plan for 2020-2022 is in place and will purposefully implement sensitization and demand generation activities to improve FP uptake beyond free contraceptive weeks.

scholarly journals Evaluating the impact of a hospital scale-up phase of a quality improvement intervention in Ghana on mortality for children under five

2019 ◽  
Author(s):  
Kavita Singh ◽  
Ilene Speizer ◽  
Pierre M Barker ◽  
Josephine Nana Afrakoma Agyeman-Duah ◽  
Justina Agula ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Infant Mortality ◽  
Scale Up ◽  
Interrupted Time Series ◽  
Post Intervention ◽  
Under Five ◽  
Facility Level ◽  
Provision Of Care ◽  
Southern Ghana

Abstract Objective To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana. Design This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes. Setting Hospitals in Southern Ghana Participants The data sources were monthly outcome data from intervention hospitals along with program records. Intervention The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols. Main outcome measures Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality. Results There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (β = −0.0024, 95% CI −0.0051, 0.0003, P < 0.10). Conclusions The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.

scholarly journals Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Scale Up ◽  
Task Shifting ◽  
Policy Framework ◽  
Framework Analysis ◽  
Community Based ◽  
System Readiness ◽  
Injectable Contraceptives

Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.

scholarly journals Scaling up Malaria Elimination Management and Leadership: A pilot in three provinces in Zimbabwe, 2016 -2018

2020 ◽  
Author(s):  
Amanda Marr Chung ◽  
Peter Case ◽  
Jonathan Gosling ◽  
Roland Gosling ◽  
Munashe Madinga ◽  
...  
Keyword(s):  
Quality Improvement ◽  
San Francisco ◽  
Organization Development ◽  
Program Effectiveness ◽  
Health Workers ◽  
Focal Point ◽  
Scale Up ◽  
Health Staff ◽  
Sphere Of Influence ◽  
Operational Issues

Abstract BackgroundFocus for improved malaria program performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria program effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. MethodsIn collaboration with the Zimbabwe Ministry of Health and Child Care (MoHCC), University of California San Francisco (UCSF), University of West of England (UWE), Clinton Health Access Initiative (CHAI) Zimbabwe, and organization development consultants from South Africa and Zimbabwe, a program of work was piloted in Zimbabwe starting with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods.ResultsWorkshop participants in Matabeleland South reported an improvement in data management, with the development of a data collection tool, the initiation of data reporting from district to province on a weekly basis, and the establishment of a data focal point in each district. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale was impacted positively. There was also an improvement in data quality and the frequency in which data was shared via weekly bulletins. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly and learned how to develop indicators to measure the process improvement changes they were making. Participants from all provinces reported having a better appreciation of the value of communication, teamwork, planning, continuous monitoring of data, and adjustment of work plans and gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria program staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. ConclusionsThis pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including inter alia: improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the program with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: a participatory, organization development and quality improvement approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

scholarly journals HOW, WHY AND UNDER WHAT CIRCUMSTANCES DOES A QUALITY IMPROVEMENT COLLABORATIVE BUILD KNOWLEDGE AND SKILLS IN CLINICIANS WORKING WITH PEOPLE WITH DEMENTIA? A REALIST INFORMED PROCESS EVALUATION

2020 ◽  
Author(s):  
Lenore A de la Perrelle ◽  
Monica Cations ◽  
Gaery Barbery ◽  
Garjana Radisic ◽  
Billingsley Kaambwa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Process Evaluation ◽  
World Health Organisation ◽  
Dementia Care ◽  
Program Theory ◽  
World Health ◽  
Quality Improvement Collaborative ◽  
Post Intervention ◽  
Knowledge And Skills ◽  
People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the World Health Organisation to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evi-dence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested, and refined the program theory of a quality improvement collaborative. Data were collected pre-and post-intervention using surveys and interviews with participants (n=24). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Seven mechanisms were identified: motivation, accountability, identity, collective learning, credibility, and reflective practice. Each of these mechanisms operated differently according to context. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge and skills of clinicians to improve dementia care. A supportive setting and a credible, flexible, and collaborative process optimises quality improvement knowledge and skills in clinicians working with people with dementia.

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