How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Tancred, Tara; Mandu, Rogers; Hanson, Claudia; Okuga, Monica; Manzi, Fatuma; Peterson, Stefan; Schellenberg, Joanna; Waiswa, Peter; Marchant, Tanya

doi:10.1093/heapol/czu070

Cited by 23 publications

(43 citation statements)

References 30 publications

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“…Unlike other studies conducted in Ethiopia, Bangladesh, and India [37][38][39], this study indicated that community participation had a positive effect on PNC coverage. This might be due to improving HEW home visits regularity, which is supported by previous studies showing that community participation improved the accountability of health care providers [33,63], and improved birth notification systems and practices of keeping women at facilities for at least 24 hours after delivery for PNC.…”

Section: Discussionmentioning

confidence: 67%

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

Tiruneh¹,

Zemichael²,

Betemariam³

et al. 2020

PLoS ONE

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Section: Discussionmentioning

confidence: 67%

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

Tiruneh¹,

Zemichael²,

Betemariam³

et al. 2020

PLoS ONE

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“…For policy makers and donors to be convinced by costing data, they must first be convinced of the benefits of what is being costed, and this has created a challenge for QI approaches generally. We have not presented data on the individual improvements achieved by the 29 improvement teams included in our study, which are similar to those observed by other community QI projects from several settings in sub-Saharan Africa 31–34 61–65. Immediate process outcomes of the QI approach we used included: improved supervision and integration of the community health programme to the health system, consensus building across levels of the health system on priority problems and improved data quality on critical health service areas—all of which have been shown to support improved performance of CTC providers 5 9 43 66 67.…”

Section: Discussionmentioning

confidence: 90%

“…Policy makers are beginning to question whether CTC providers can achieve equitable service quality at low cost 29. Evidence is growing for systematically incorporating quality improvement (QI) approaches into community health programmes in low-income and middle-income countries, especially in maternal and child health 30–34. These community-level approaches appear to have been successful in terms of improving the quality and equity of services, but there is limited information about costs or cost-effectiveness of implementation 32 34.…”

Section: Introductionmentioning

confidence: 99%

Is quality affordable for community health systems? Costs of integrating quality improvement into close-to-community health programmes in five low-income and middle-income countries

et al. 2019

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IntroductionCountries aspiring to universal health coverage view close-to-community (CTC) providers as a low-cost means of increasing coverage. However, due to lack of coordination and unreliable funding, the quality of large-scale CTC healthcare provision is highly variable and routine data about service quality are not trustworthy. Quality improvement (QI) approaches are a means of addressing these issues, yet neither the costs nor the budget impact of integrating QI approaches into CTC programme costs have been assessed.MethodsThis paper examines the costs and budget impact of integrating QI into existing CTC health programmes in five countries (Ethiopia, Indonesia, Kenya, Malawi, Mozambique) between 2015 and 2017. The intervention involved: (1) QI team formation; (2) Phased training interspersed with supportive supervision; which resulted in (3) QI teams independently collecting and analysing data to conduct QI interventions. Project costs were collected using an ingredients approach from a health systems perspective. Based on project costs, costs of local adoption of the intervention were modelled under three implementation scenarios.ResultsAnnualised economic unit costs ranged from $62 in Mozambique to $254 in Ethiopia per CTC provider supervised, driven by the context, type of community health model and the intensity of the intervention. The budget impact of Ministry-led QI for community health is estimated at 0.53% or less of the general government expenditure on health in all countries (and below 0.03% in three of the five countries).ConclusionCTC provision is a key component of healthcare delivery in many settings, so QI has huge potential impact. The impact is difficult to establish conclusively, but as a first step we have provided evidence to assess affordability of QI for community health. Further research is needed to assess whether QI can achieve the level of benefits that would justify the required investment.

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“…As such, the primary volunteer activities of communitylevel quality improvement were attending learning sessions, attending monthly meetings, and creating, implementing, testing, and monitoring change ideas using PDSA cycles. For more information, communitylevel quality improvement within EQUIP is described in greater detail elsewhere (Tancred et al, 2014 Overall total /100…”

Section: Community-level Interventionmentioning

confidence: 99%

Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania

et al. 2016

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A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention’s implementers was undertaken in four villages receiving the intervention to evaluate the intervention’s implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future.

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How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Abstract: 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.

Cited by 23 publications

References 30 publications

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

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

Is quality affordable for community health systems? Costs of integrating quality improvement into close-to-community health programmes in five low-income and middle-income countries

Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania

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