Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger.

PURPOSE: The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high-impact, evidence-based care standards. Intervention costs and cost-effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale-up the intervention to additional sites. DESIGN/METHODOLOGY/APPROACH: Facility-based maternal care outcomes and costs from pre-quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records. FINDINGS: The average delivery-cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost-effectiveness was $147/disability-adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost-savings and improved health outcomes can be predicted. PRACTICAL IMPLICATIONS: The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources. ORIGINALITY/VALUE: This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.

Managing hundreds of improvement teams.

Recognizing the notable scale of USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project activities and sizable number of improvement teams, which in some cases is close to 1,000 improvement teams managed in one country at a point in time, we sought to answer the questions: How do we manage hundreds of improvement teams in one country alone? How do we manage more than 4,000 improvement teams globally? The leaders of our improvement programs manage such efforts as though they are second-nature, without pointing to the specific skills and strategies needed to manage thousands of teams. This paper was developed to capture the lessons, considerations, and insights shared in discussions with leaders on the USAID ASSIST Project, including country Chiefs of Party and Regional Directors. More specifically, this paper seeks to describe what is involved in scaling up and managing large numbers of improvement teams. Through focus group discussions and individual interviews, participants discussed the key skills, strategies, and lessons needed to successfully manage large numbers of teams on the USAID ASSIST Project. We concluded that the six key components in managing large numbers of teams are 1) leadership; 2) management structures and capacities; 3) clear and open communication; 4) shared learning, collaboration, and support; 5) ownership, engagement, and empowerment; and 6) partnerships. We further analyzed these six components as being interrelated to one another based on the relationship between culture, strategy, and technique in implementing quality improvement activities.

The role of research in developing job aids for pneumonia treatment in Niger.

OBJECTIVE: To use qualitative research to develop a complementary set of job aids to improve adherence to cotrimoxazole for childhood pneumonia and to improve provider-client counseling. DESIGN: Qualitative research on existing knowledge and practices of parents and providers using key informant interviews, focus groups, clinic observation, and home visits. A workshop of local stakeholders produced messages and job aids for health care workers and parents that included counseling cards and posters for providers, and medication envelopes with educational messages for mothers. Draft mock-ups were tested, modified, and re-tested before final production and distribution. SETTING: Boboye District, Niger. STUDY PARTICIPANTS: Clinic health care workers, mothers of children with pneumonia, and key informants. RESULTS: A complementary set of counseling tools, or job aids, was designed based on consensus developed during the workshop, leading to greater buy-in and local support. CONCLUSION: Behavior change communication theory and qualitative research can be applied to the design of key messages on adherence to an antibiotic regimen and corresponding job aids for both parents and health care workers. This approach generates enthusiastic support from local participants.