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  • Human Resources for Health in Maternal, Neonatal, and Reproductive Health at the Community Level: A Synthesis of the Literature with a focus on the Asia Pacific Region | Community Resource

    This literature review provides examples of lessons learned in the planning, implementation and evaluation of HRH interventions in maternal, neonatal and reproductive health (MNRH) at the community level in the Asia and Pacific regions. The review outlines interventions in the areas of HRH policy, management, and education and training. It synthesizes what are considered effective ways of working with the community and ways towards building supportive environments for health workers. 

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  • Assessing Community Capacity for Change | Community Resource

    The purpose of the tool is to learn and understand more about community capacity - what it is, how it can be assessed, and how it can be strengthened. The tool is an assessment process that engages communities in capacity assessment. There are seven domains including: sense of community; communication; participation; leadership; resources, knowledge, and skills; and ongoing learning. 

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  • Community-Driven Tools for Data Collection and Decision Making: The PISA Action Guide | Community Resource

    The PARTICIPATORY INFORMATION SYSTEMS APPRAISAL (PISA) Action Guide systematically introduces and explains the concepts and strategies needed to make well informed, data-based decisions while empowering key stakeholders in the process. The action guide outlines team preparation activities, data collection methods, data analysis and action planning, and team learning & follow up activities. Local facilitators and key project stakeholders are actively involved in data instrument design, collection, reporting and analysis.

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  • How to Mobilize Communities for Health and Social Change | Community Resource

    This field guide is designed for health program directors and managers of community-based programs who are considering using community mobilization to improve health at the individual, family, and community level. The field guide contains illustrative examples and lessons learned in community mobilization experiences from around the world, focusing on working with disadvantaged or marginalized groups in developing countries.

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  • Effectively Linking Communities and Facilities in Assam, India | Improvement Report
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  • IMPROVING ACCESS TO HEPATITIS PREVENTION AND CARE IN SINDH PAKISTAN | Improvement Report
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  • Engaging Pharmacies to Control Tuberculosis (TB) in India | Improvement Report
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  • Qualitative Process Evaluation of the Implementation and Evolution of Community-Based Quality Improvement for EONC | Afghanistan | Publications

     

    This study proposes to document and describe the development, evolution and early lessons learned from applying modern quality improvement (QI) methods to strengthen coverage, quality, and health systems linkages of community-level maternal and newborn care services in Afghanistan. While QI methods and approaches have been extensively implemented at the facility level for improving maternal and newborn care in developing countries, little is known about best practices for implementing QI at the community level to improve community health worker service delivery, community stakeholder engagement, and critical community linkages to the formal health system. HCI began implementing such activities in Afghanistan and Mali in 2010. This study will use focus group discussions (FGDs) with community-based QI stakeholders as part of data collection to answer two questions: First, what strategies and methods did key stakeholders perceive as effective at facilitating the QI process at the community level? Second, how did CHWs and other key stakeholders modify initially ineffective strategies and methods in order to facilitate community-based QI? The results of this study will be used to determine best practices for future scale-up.
     
    This study uses a mixed methods design, with quantitative data from concurrent study efforts providing a backdrop for the primary qualitative results. The most useful data for improving the efficiency of the community-based QI method is expected to come from consensus as a result of interaction of a group of individuals with knowledge of the community-based QI process at different levels. Focus group discussions will be conducted with CHWs and community stakeholders from four to five health facility catchment areas where community-based QI collaboratives are being implemented. The goal of the FGDs is to elicit responses which will reveal methods and strategies most relevant to the successful implementation of the community-based QI program. 

     

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  • Feasibility of Proposed Quality Criteria for Monitoring and Improving HIV Services | Publications

    At the request of the Office of the Global AIDS Coordinator (OGAC), the United States Agency for International Development (USAID) and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund), the USAID Health Care Improvement Project (HCI) developed an approach to yield meaningful information about the quality of HIV services for users at multiple levels of the health system. The approach proposes 16 quality criteria (QC) that were assessed through 25 existing indicators. The indicators were based on measures previously required or recommended by funders and other stakeholders, such as the Global Fund, PEPFAR, and the World Health Organization. This report presents the findings from a field test of the approach in five countries in three world regions: Africa, Eurasia, and Southeast Asia.

    As a result of its findings, the report offers three recommendations:
     
    1.) Increase facilities’ ability to use indicator data by requiring denominators that reflect the number of patients who visit a facility;
    2.) Encourage monthly monitoring and the use of data to make decisions to manage and improve care processes; and
    3.) Improve the use and reporting of quality criteria data by: (a) supporting countries in using up-to date, centralized record systems to record patient status, (b) establishing systems to track and ensure attendance, (c) linking different service areas, and (d) supporting countries in building capacity to use their data to make decisions and improve the quality of their services.
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  • Lessons on national and international use of metrics to improve health systems | Publications

    This presentation was given by Amy Stern, Senior QI Advisor on HCI, at the 28th International Conference of the International Society for Quality in Health Care, Ltd. (ISQua), which took place in Hong Kong, China from September 14-17, 2011. The conference theme was, “Patient Safety: Sustaining the Global Momentum.”

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  • Feasibility of Using Quality Criteria to Monitor and Improve the Quality of HIV Services | Publications

    This short report describes assistance that the USAID Health Care Improvement Project (HCI) is providing to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and to the Office of the Global AIDS Coordinator (OGAC) to develop an approach that can be used to harmonize global reporting and improve the quality of HIV services and health outcomes. This study details HCI’s approach that employs 16 quality criteria for 5 HIV service delivery areas: testing and counseling, care and treatment, PMTCT, TB/HIV, and harm reduction. Field tests were conducted in five selected countries: 3 in Africa, 1 in Eurasia and 1 in Southeast Asia.  

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  • Validity of Patient Data Records in Maternal and Newborn Health Facilities | Afghanistan | Publications

    Continuous quality improvement (CQI) efforts in health care often rely on quality improvement (QI) teams performing self-assessments of compliance with standards of care. This is often the most efficient method of data collection for performance indicators and is therefore frequently used in resource-constrained settings (L Franco 2009). Some have found health provider self-assessment to be effective in improving performance in circumstances where higher level supervision is unavailable (E Kelly 2003). Information from such assessment is crucial to design the CQI intervention, identify performance gaps that require attention and allow the QI team to monitor its progress in improving the process of health care delivery (Vos 2010). It is therefore essential that these data be a valid representation of performance.

    The Health Care Improvement Project (HCI) has been implementing collaborative QI interventions in hospitals in Kabul since November 2009. HCI staff started data collection and gradually delegated it to QI teams in respective facilities.
     
    The MoPH is interested in determining the validity of data collected by health facility and hospital staff. There are concerns the patient medical charts and outcomes registers and do not accurately reflect the true clinical picture, possibly due to resource constraints and very heavy patient loads. If deficits are found in data collection and reporting, then the HCI project team can focus more of its improvement activities to address this in order to be able to accurately inform the intervention. 
     
    No validity study of this sort has been done in Afghanistan to date. This study will help determine the validity of data collected by HCI and will provide a method that the MoPH can use to validate its HMIS data. It will help determine gaps in data collection and guide interventions to improve data quality in the future.
     
    Research questions/objectives:
    This study proposes to investigate the validity of data collected by QI teams in maternity facilities in Kabul. There are 3 specific research questions to be addressed:
    1. 1. To what extent are the data reported on patient charts and the register representative of what happened during childbirth?
    2. 2. What factors are associated with the validity of the self-assessment data collected from participating maternity hospitals? Factors to be tested include the cadre of the health worker, their level of experience, the type of facility and the time of day of the delivery.
    3. 3. What is the level of compliance to standards of clinical practice seen in the deliveries observed?
     
    Methodology:  
    We propose an observational cross-sectional study to be conducted in three maternity hospitals in Kabul. The study will consist of trained research assistants (MDs) observing deliveries taking place in participating hospitals then checking the findings from a review of charts and registers to determine if there is consistency in what was observed during the delivery and what is seen in the medical record.

     

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  • Evaluating Spread of the MNCH Collaborative to Bamiyan, Herat and Parwan | Afghanistan | Publications

    The collaborative model of quality improvement aims at testing and implementing Quality Improvement (QI) interventions on a small scale, synthesizing the most robust and effective changes, and spreading them at scale. Collaborative improvement not only generates improvements in the quality of care delivered in these initial sites, but also develops organizational learning. However, there still exist knowledge gaps on how to successfully spread evidence practices and ensure up-take and continuous application of these practices in resource-limited settings.

    The study examines the process of spread of improvements from the demonstration phase of the MNCH Facilities Collaborative in Balkh and Kunduz to three new provinces: Parwan, Herat, and Bamiyan.  In the demonstration phase, different change ideas are tested and an intervention package composing of these change ideas and interventions that yield high outcomes will be prepared and used for scale up to the three new provinces. The aim of the spread study is to evaluate the uptake and implementation of a package of changes—which originated in the demonstration phase—in Bamyan, Parwan and Herat.

    The study will include both qualitative and quantitative methods to understand:
    • How sites in new provinces react to and take up improvements coming from the demonstration phase
    • How the applicability and effectiveness of QI methodology in improving quality of health care differs in new settings
    Research questions/objectives:
    • Which ‘change ideas’ were adopted, modified or rejected by health facilities in the three new provinces
    • How were the ‘change ideas’ communicated to the sites, and what were the reasons behind the uptake of each ‘change idea’?
    • Were there specific reasons that facilitated or hindered the uptake of change ideas? What were they and what are QI participants perspectives on them?
    • What were the most successful means of spreading of quality improvement changes?
    Methodology:  
    This is a cross-sectional study which includes both qualitative and quantitative methods. A quantitative section will record data on the number and proportion of change ideas adopted or rejected by health facilities, and reasons for those decisions. These close-ended quantitative items, as well as open-ended questions, will be administered during a structured interview. If necessary, in-depth interviews with key informants will be conducted to expand on points of interest and clarify potential gaps in results.

     

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  • Community Health Workers: A Review of Concepts, Practice, and Policy Concerns | Community Resource

    This literature review provides an overview of the concepts and practices among CHWs from across a range of developing and developed countries. The authors review various ways that CHWs have been used in different settings and analyze the role, management, and other factors that influence performance of CHWs. They also illustrate some of the policy challenges that exist in designing effective CHW programs in the Indian context.

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  • Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems | Community Resource

    This report aims to identify CHW programs with positive impacts on Millennium Development Goals (MDGs), related to health or otherwise, through a global systematic review undertaken of such interventions, as well as eight in-depth country case studies in SubSaharan Africa (Ethiopia Mozambique and Uganda), South East Asia (Bangladesh, Pakistan and Thailand) and Latin America (Brazil and Haiti).

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  • Factors Affecting Recruitment and Retention of Community Health Workers in a Newborn Care Intervention in Bangladesh | Community Resource

    This study investigates reasons for high rates of CHW attrition in Sylhet District in northeastern Bangladesh. The framework presented in this paper illustrates the decision-making process women go through when deciding to become, or continue as, a CHW. Factors such as job satisfaction, community valuation of CHW work, and fulfillment of pre-hire expectations all need to be addressed systematically by programs to reduce rates of CHW attrition.

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  • Improving Performance of Community-Level Health and Nutrition Functionaries: A Review of Evidence in India | Community Resource

    This review of the National Rural Health Mission (NRHM) and the Integrated Child Development Scheme (ICDS) III which highlights lack of supervision, poor worker motivation, and related issues as critical challenges. It shows that programs often focus on training but other performance factors such as supportive supervision, clear performance expectations and motivation and recognition are often neglected. These factors may be constraints against improving health and nutrition programs in India.

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  • Country Case Study: Pakistan's Lady Health Worker Programme | Community Resource

    This case study describes the rationale, implementation strategies, achievements and challenges of a programme that created a new cadre of female health workers in Pakistan to address unmet health needs of rural populations and slum dwellers. An external evaluation of the programme in 2000 found that the population served by Lady Health Workers had substantially better health indicators than the control population.

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  • Daily diary analysis – An approach to strengthen information system at grass root level | Improvement Report
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  • PSYCOLOGICAL CARE IN NEUROCOGNITIVE DYSFUNTION RESULTING FROM HIV AIDS | Improvement Report
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