Tara Tancred1,2, Rogers Mandu3, Claudia Hanson2,4, Monica Okuga3, Fatuma Manzi1, Stefan Peterson3,4,5, Joanna Schellenberg2, Peter Waiswa3,4, Tanya Marchant2. 1. Ifakara Health Institute, Dar es Salaam, Tanzania. 2. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK. 3. Makerere University School of Public Health, Kampala, Uganda. 4. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 5. The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Abstract
BACKGROUND: Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. AIM: To describe experiences implementing EQUIP's QI approach at the community level. METHODS: A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. RESULTS: Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. CONCLUSIONS: Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine
BACKGROUND: Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. AIM: To describe experiences implementing EQUIP's QI approach at the community level. METHODS: A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. RESULTS: Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. CONCLUSIONS: Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine
Keywords:
Community participation; community mobilization; developing countries; health care seeking behaviour; health systems; maternal and child health; participatory research; qualitative research
Authors: Sonia Ahmed; Liana E Chase; Janelle Wagnild; Nasima Akhter; Scarlett Sturridge; Andrew Clarke; Pari Chowdhary; Diana Mukami; Adetayo Kasim; Kate Hampshire Journal: Int J Equity Health Date: 2022-04-11
Authors: Ezequiel Garcia-Elorrio; Samantha Y Rowe; Maria E Teijeiro; Agustín Ciapponi; Alexander K Rowe Journal: PLoS One Date: 2019-10-03 Impact factor: 3.240