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Sustaining Better Maternal and Newborn Care and Quality Improvement in Niger: Challenges and Successes | Niger
Research & Evaluation Study Profiles
Organization:
USAID Health Care Improvement Project/URC
Topics: Active management of the third stage of labor, Antenatal care, Essential newborn care, Essential obstetric care, Post-partum care
Region and Country: Niger
Partners:
Ministry of Public Health
Year:
2011
Language:
English Description:
Little research has been done to characterize or describe the level of institutionalization achieved at the end of formal collaborative improvement activities. Beginning in 2006, the Ministry of Health (MOH) of Niger, with support from the USAID Health Care Improvement Project (HCI) initiated efforts to reduce maternal and newborn mortality with an integrated package of evidence-based practices in essential obstetric and newborn care (EONC), introduced with a collaborative improvement strategy. These efforts led to significant gains in quality of services, and when external technical support for these activities ended in December 2008, it presented the opportunity to study whether the gains achieved during the program could be sustained.
This study began with an initial assessment of institutionalization after HCI funding ended in order to help the MOH of Niger develop a strategy to strengthen maintenance of gains in care quality achieved during the program and integration of quality improvement into the Niger health system. This assessment was followed by another to measure the situation a year later. The specific objectives of the study were to:
1. Determine the degree of institutionalization of quality care and of QI implementation, at site, district, regional and central levels and its evolution over time.
2. Identify factors that facilitated or hindered institutionalization of quality of care and QI at all levels of the system over time.
3. Describe the extent of implementation of the MOH’s “institutionalization change package”, including its integration into annual action plans and requisite resource mobilization at the different levels of the system.
The study found that participating in collaborative improvement builds technical and organizational capacity to maintain gains in quality over time and builds QI skills needed to maintain quality of care. It further found that improvement focused on one technical area can build skills to apply subsequently to other technical areas.
In addition to their application in Niger, the results of this research can help quality improvement programs in other countries by providing leaders with key information about how to strengthen institutionalization within the context of collaborative improvement (or other QI approach) implementation. It suggests that a minimum set of QI activities (less than those implemented as part of collaborative improvement) can maintain gains in quality of care even in areas of high staff mobility; and that hospital management, district/regional leaders, and national level actors have specific QI roles to play to ensure maintenance of gains in quality and continued practice of QI.
