Follow Us HCI Project on FacebookHCI Project on TwitterHCI Project on Vimeo
Why Register?     Register      Login

Aligning and Clarifying Health Worker Tasks to Improve Maternal Care in Niger

Crigler L | Boucar M | Wittcoff A | Isenhower W | Wuliji T
Organization: USAID Health Care Improvement Project/URC

Topics: Employee Engagement, Maternal, Newborn and Child Health, Performance management, Supervision, Task definition

Region and Country: Niger

Initiatives Inc.

Throughout Africa, the human resources crisis in the public health system has become one of the biggest challenges in attaining the Millennium Development Goals (MDGs). In the face of difficult working environments and inadequate support, health workers are often unprepared and unable to meet the high demands placed on them; they lose motivation, become disengaged, or vacate their posts altogether.   This report describes pioneering work in Niger by the USAID Health Care Improvement Project (HCI) to apply quality improvement methods to strengthen human resources management and performance at the facility- and district-management level to improve maternal care in the Tahoua Region.   

Since May 2009, 15 health facility and 11 district management quality improvement (QI) teams have worked together with the support of the Ministry of Public Health (MOPH) in Niger and the USAID HCI Project. This work uses the QI Collaborative approach to develop, test, implement, and spread feasible strategies targeting specific human resources improvement objectives to improve maternal care services. As part of this strategic human resources management process to improve maternal care, teams aligned maternal health goals and objectives from the central to facility levels, and clarified and defined tasks and competencies for clinical staff in maternity units. Regional and district health teams continue to implement system changes while facility teams focus on improving performance and providing support to engage health workers.

These improvements resulted in significant clinical, performance and efficiency gains between May 2009 and December 2010: six out of the Tahoua region’s eight districts now meet the national target for the percentage of births (i.e., greater than 25%) delivered in a health facility; postpartum hemorrhage has been reduced by half in participating sites; adherence to essential newborn care standards has increased from 72% to 98%; and the average waiting time for pre-natal consultations has been reduced by 50-98%. When the collaborative started, none of the health workers had job descriptions, whereas now, almost all health workers have specific, written job descriptions and clear roles and responsibilities outlined for their work. Results from this program demonstrate that by building the capacity of health workers and district managers in teams to solve problems that affect their ability to provide maternal care, performance, productivity, efficiency, quality of care, and clinical indicators are sustainably improved over time.