Strengthening routine data reporting in private hospitals in Lagos, Nigeria.

The availability of routine health information is critical for effective health planning, especially in resource-limited countries. Nigeria adopted the web-based District Health Information System (DHIS) to harmonize the collection, analysis and storage of data for informed decision-making. However, only 44% of all private hospitals in Lagos State reported to the DHIS despite constituting 90% of all health facilities in the state. To bridge this gap, this study implemented targeted interventions. This paper describes (1) the implemented interventions, (2) the effects of the interventions on data reporting on DHIS during the intervention period and (3) the evaluation of data reporting on DHIS after the intervention period in select private hospitals in Lagos State. A five-pronged intervention was implemented in 55 private hospitals (intervention hospitals), which entailed stakeholder engagement, on-the-job training, in-facility mentoring and the provision of data tools and job aids, to improve data reporting on DHIS from 2014 to 2017. A controlled before-and-after study design was employed to assess the effectiveness of the implemented interventions. A comparable cohort of 55 non-intervention private hospitals was selected, and data were extracted from both groups. Data analysis was conducted using paired and independent t-tests to assess the effect and measure the difference between both groups of hospitals, respectively. An average increase of 65.28% (P < 0.01) in reporting rate and 50.31% (P < 0.01) in the timeliness of reporting on DHIS was seen among intervention hospitals. Similarly, the difference between intervention and non-intervention hospitals post-intervention was significantly different for both data reporting (mean difference = -22.38, P < 0.01) and timeliness (mean difference = -18.81, P < 0.01), respectively. Furthermore, a sustained improvement in data reporting and timeliness of reporting on DHIS was observed among intervention hospitals 24 months after interventions. Thus, implementing targeted interventions can strengthen routine data reporting for better performance and informed decision-making.

Influence of context on quality improvement priorities: a qualitative study of three facility types in Lagos State, Nigeria.

BACKGROUND: Quality improvement (QI) collaboratives are increasingly popular. However, there is a need for an in-depth understanding of the influence of context on its implementation. We explored the influence of context on the change concepts considered by public primary (primary health centres), public secondary (public hospitals) and private (private facilities) collaboratives established to improve maternal and newborn health outcomes in Lagos State, Nigeria. METHODS: Between February 2019 and January 2020, we conducted a qualitative study using meeting reports, key informant interviews and participant observation. Data were analysed using the high-quality health system framework for assessing health system and user experience that distinguished three quality domains: quality impacts, processes of care and health system foundations. RESULTS: Nineteen change concepts and 158 change ideas were observed across 28 facility QI teams. Change concepts and ideas prioritised were influenced by government and non-governmental leaders but ultimately shaped by facility QI capacity, time allocated for QI activities and availability of local data. Of the three quality domains, process of care, including patient satisfaction, received the most attention across facility types. There was considerable variation in the change concepts considered across domains. For example, more public hospitals focused on complication management because of a relatively high prevalence of and capacity to manage maternal complications; primary health centres focused more on complication referrals, while private facilities prioritised revenue generation. Problems with availability of resources were particularly highlighted in primary health centres which had relatively less financial commitment from stakeholders. CONCLUSION: Our findings provide insights into QI collaboratives' mechanism of change in which external stakeholders, including government, drove QI priorities for action but the ultimate decisions depended on local realities of facilities. Our findings underscore the need for strong QI leadership and sufficient resources to enable facility QI teams to prioritise change concepts for greater health impact.

From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context.

As countries continue to invest in quality improvement (QI) initiatives in health facilities, it is important to acknowledge the role of context in implementation. We conducted a qualitative study between February 2019 and January 2020 to explore how a QI initiative was adapted to enable implementation in three facility types: primary health centres, public hospitals and private facilities in Lagos State, Nigeria.Despite a common theory of change, implementation of the initiative needed to be adapted to accommodate the local needs, priorities and organisational culture of each facility type. Across facility types, inadequate human and capital resources constrained implementation and necessitated an extension of the initiative's duration. In public facilities, the local governance structure was adapted to facilitate coordination, but similar adaptations to governance were not possible for private facilities. Our findings highlight the importance of anticipating and planning for the local adaptation of QI initiatives according to implementation environment.