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Tancred, Tara; Mandu, Rogers; Hanson, Claudia; Okuga, Monica; Manzi, Fatuma; Peterson, Stefan; Schellenberg, Joanna; Waiswa, Peter; Marchant, Tanya (2018)
Publisher: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
Languages: English
Types: Article
Subjects: Public Health, Global Health, Social Medicine and Epidemiology, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
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.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • Adam T, Lim SS, Mehta S et al. 2005. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. British Medical Journal 331: 1107.
    • Bhutta Z, Lassi Z, Pariyo G, Huicho L. 2011. Global Experience of Community Health Workers for Delivery of Health-Related Millennium Development Goals: A Systematic Review, Counry Case Studies, and Recommendations for Integration into National Health Systems. Geneva: World Health Organization, Global Health Workforce Alliance.
    • Bhutta ZA, Chopra M, Axelson H et al. 2010. Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival. Lancet 375: 2032-44.
    • Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. 2005. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 115: 519-617.
    • Bloor G. 1999. Organisational culture, organisational learning and total quality management: a literature review and synthesis. Australian Health Review 22: 162-79.
    • Braunack-Mayer A, Louise J. 2008. The ethics of community empowerment: tensions in health promotion theory and practice. Promotion & Education 15: 5-8.
    • Buchanan DR, Miller FG, Wallerstein N. 2007. Ethical issues in community-based participatory research: balancing rigorous research with community participation in community intervention studies. Progress in Community Health Partnerships 1: 153-60.
    • Colbourn T, Nambiar B, Bondo A et al. 2013. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial. International Health 5: 180-95.
    • Cornwall A, Jewkes R. 1995. What is participatory research? Social Science Medicine 41: 1667-76.
    • Doran G. 1981. There's a S.M.A.R.T. way to write management's goals and objectives. Management Review 70: 35-9.
    • du Mortier S, Arpagaus M. 2005. Quality improvement programme on the frontline: an International Committee of the Red Cross experience in the Democratic Republic of Congo. International Journal for Quality in Health Care 17: 293-300.
    • EQUIP. 2011. EQUIP: Expanded Quality Improvement Using Information Power. http://www.equip-project.eu/, accessed 18 February 2012.
    • Flicker S, Travers R, Guta A, Mcdonald S., Meagher A. 2007. Ethical dilemmas in community-based participatory research: recommendations for institutional review boards. Journal of Urban Health 84: 478-93.
    • Hanson C. 2013. The Epidemiology of Maternal Mortality in Southern Tanzania. Ph.D. Thesis, London School of Hygiene and Tropical Medicine.
    • Hanson C, Waiswa P, Marchant T et al. 2014. Expanded quality management using information power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda. Implement Sci 9: 41.
    • Hunt P, Backman G. 2008. Health systems and the right to the highest attainable standard of health. Health and Human Rights 10: 81-92.
    • Imdad A, Bhutta ZA. 2013. Nutritional management of the low birth weight/preterm infant in community settings: a perspective from the developing world. Journal of Pediatrics 162: S107-14.
    • Langley G. 2009. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass.
    • Larsson EC, Thorson AE, Pariyo G et al. 2012. Missed opportunities: barriers to HIV testing during pregnancy from a population based cohort study in rural Uganda. PLoS One 7: e37590.
    • Manandhar DS, Osrin D, Shrestha BP et al. 2004. Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet 364: 970-9.
    • Marston C, Renedo A, Mcgowan CR, Portela A. 2013. Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review. PLoS One 8: e55012.
    • Mayuge District Government. 2010. Mayuge District Government Five-Year Plan 2010/2011-2014/2015. Kampala. http://npa.ug/wp-content/ themes/npatheme/documents/East/Mayuge DDP.pdf, accessed July 2013.
    • Mkai C, Mbogoro D. 2004. The Regional and District Census Brief. Dar es Salaam.
    • More NS, Bapat U, Das S et al. 2008. Cluster-randomised controlled trial of community mobilisation in Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn. Trials 9: 7.
    • Morgan LM. 2001. Community participation in health: perpetual allure, persistent challenge. Health Policy Plan 16: 221-30.
    • Moyer CA, Dako-Gyeke P, Adanu RM. 2013. Facility-based delivery and maternal and early neonatal mortality in sub-Saharan Africa: a regional review of the literature. African Journal of Reproductive Health 17: 30-43.
    • Nahar T, Azad K, Aumon BH et al. 2012. Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh. BMC Pregnancy Childbirth 12: 5.
    • National Bureau of Statistics. 2013. Population distribution by administrative units: 2012 population and housing census. Dar es Salaam, Tanzania: The United Republic of Tanzania.
    • National Bureau of Statistics and ICF Macro. 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: National Bureau of Statistics and ICF Macro.
    • O'Rourke K, Howard-Grabman L, Seoane G. 1998. Impact of community organization of women on perinatal outcomes in rural Bolivia. Rev Panam Salud Publica 3: 9-14.
    • Pope C, Ziebland S, Mays N. 2000. Analysing qualitative data. British Medical Journal 320: 114-16.
    • Prata N, Sreenivas A, Vahidnia F, Potts M. 2009. Saving maternal lives in resource-poor settings: facing reality. Health Policy 89: 131-48.
    • Prost A, Colbourn T, Seward N et al. 2013. Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet 381: 1736-46.
    • Rutenberg N, Watkins SC. 1997. The buzz outside the clinics: conversations and contraception in Nyanza Province, Kenya. Studies in Family Planning 28: 290-307.
    • Schiffman J, Darmstadt GL, Agarwal S, Baqui AH. 2010. Communitybased intervention packages for improving perinatal health in developing countries: a review of the evidence. Seminars in Perinatology 34: 462-76.
    • Shah IH, Say L. 2007. Maternal mortality and maternity care from 1990 to 2005: uneven but important gains. Reproductive Health Matters 15: 17-27.
    • Shaikh BT, Hatcher J. 2005. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. Journal of Public Health 27: 49-54.
    • Sibley LM, Tesfaye S, Fekadu Desta B et al. 2014. Improving maternal and newborn health care delivery in rural amhara and oromiya regions of ethiopia through the maternal and newborn health in ethiopia partnership. Journal of Midwifery Womens Health 59(Suppl. 1):S6-S20.
    • The Planning Commission United Republic of Tanzania. 1997. Mtwara Region Socioeconomic Profile. Dar es Salaam: Regional Commissioner's Office, Mtwara.
    • Uganda Bureau of Statistics. 2009. 2009 Statistical Abstract. Kampala, Uganda: Uganda Bureau of Statistics.
    • Uganda Bureau of Statistics & ICF International. 2012. Uganda Demographic and Health Survey 2011. Kampala, Uganda, Calverton, Maryland: Uganda Bureau of Statistics and ICF International.
    • Umar N, Litaker D, Terris DD. 2009. Toward more sustainable health care quality improvement in developing countries: the ''little steps'' approach. Quality Management in Health Care 18: 295-304.
    • United Nation's Children's Fund (UNICEF), World Health Organization (WHO), United Nation's Department of Economic and Social Affairs (UNDESA) and The World Bank. 2012. Mortality Rate, Neonatal (Per 1,000 Live Births). Washington, DC: The World Bank.
    • United Nations. 2013. The Millennium Development Goals Report 2013. New York: United Nations.
    • United Nations Department of Economic and Social Affairs. 2011. The Millennium Development Goals Report. New York: United Nations; Department of Economic and Social Affairs.
    • Wallin L, Malqvist M, Nga NT et al. 2011. Implementing knowledge into practice for improved neonatal survival; a cluster-randomised, community-based trial in Quang Ninh province, Vietnam. BMC Health Services Research 11: 239.
    • WHO, UNICEF, UNFPA and THE World Bank. 2012. Trends in Maternal Mortality: 1990 to 2010. Geneva: The World Bank.
    • World Health Organization. 2007. Everybody's Business: Strengthening Health Systems to Improve Health Outcomes-WHO's Famework for Action. Geneva, Switzerland: World Health Organization.
    • World Health Organization. 2010. Working with Individuals, Families, and Communities to Improve Maternal and Newborn Health. Geneva, Switzerland: World Health Organization.
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