Effects of a participatory community quality improvement strategy on improving household and provider health care behaviors and practices: a propensity score analysis

Abstract

BackgroundMaternal and newborn health care intervention coverage has increased in many low-income countries over the last decade, yet poor quality of care remains a challenge, limiting health gains. The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services, responsive to community needs. Aligned with this, a Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers’ and households’ practices.MethodsPCQI engages communities in identifying barriers to access and quality of services, and developing, implementing and monitoring solutions. Thirty-four intervention kebeles (communities), which included the L10 K Platform, BEmONC, and PCQI, and 82 comparison kebeles, which included the L10 K Platform and BEmONC, were visited in December 2010–January 2011 and again 48 months later. Twelve women with children aged 0 to 11 months were interviewed in each kebele. Propensity score matching was used to estimate the program’s average treatment effects (ATEs) on women’s care seeking behavior, providers’ service provision behavior and households’ newborn care practices.ResultsThe ATEs of PCQI were statistically significant (p < 0.05) for two care seeking behaviors — four or more antenatal care (ANC) visits and institutional deliveries at 14% (95% CI: 6, 21) and 11% (95% CI: 4, 17), respectively — and one service provision behavior — complete ANC at 17% (95% CI: 11, 24). We found no evidence of an effect on remaining outcomes relating to household newborn care practices, and postnatal care performed by the provider.ConclusionsNational BEmONC strengthening and government initiatives to improve access and quality of maternal and newborn health services, together with L10 K Platform activities, appeared to work better for some care practices where communities were engaged in the PCQI strategy. Additional research with more robust measure of impact and cost-effectiveness analysis would be useful to establish effectiveness for a wider set of outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1977-9) contains supplementary material, which is available to authorized users.

Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

“…These findings are in line with a systematic review of participatory learning and action cycles with women's groups reporting improved clean home-delivery practices and uptake of any ANC [35], and with other studies on participatory community QI approaches that reported improved use of maternal health services [33,37].…”

“…Mixed findings were reported from women's group trials. It is in line with a previous quasi-experimental study in Ethiopia that engaged communities in identifying barriers to access and quality of services and reported an 11 percentage-point increase in average treatment effect in institutional deliveries [37]. But it is inconsistent with other studies elsewhere.…”

“…reduction in newborn mortality [36]. Another observational study in Ethiopia indicated that QI approaches increase use of maternal care services [37]. There is, however, no sufficient evidence that community participation is associated with better maternal health outcomes, such as improving service access, use, quality, or responsiveness [33,34].…”

“…There is, however, no sufficient evidence that community participation is associated with better maternal health outcomes, such as improving service access, use, quality, or responsiveness [33,34]. Particularly, the effect of community-participation on the uptake of skilled care and immediate postnatal care is not well documented [33,[37][38][39].…”

“…The project implemented the PC-Solutions strategy in eight of the 115 L10K 2020 Platform woredas (two in each region) between March 2016 and October 2017. This integrated intervention joined communities (including health posts) and facilities (health centers) and built on two previous JSI interventions; Participatory Community Quality Improvement and Early Care-Seeking and Referral Solutions [37,48,49]. PC-Solutions emphasized quality of care throughout the primary health care level by including communities, along with providers and managers at the primary health care level and the woreda health office, as a critical constituency.…”