Evaluations & Reviews

Using Quality Assessment to Improve Maternal Care in Nicaragua

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’s description]

Cost-Effectiveness of Self-Assessment and Peer Review in Improving Family Planning Provider-Client Communication in Indonesia

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated.

Assessing Health Worker Performance of IMCI in Kenya

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

Perceptions of Health Workers about Conditions of Service: a Namibian Case Study

This study was implemented as part of the EQUINET theme work on Human Resources for Health coordinated by Health systems Trust. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors. [from executive summary]

Quality and Effectiveness of Different Approaches to Primary Care Delivery in Brazil

Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4-6 lay community health workers. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. The main objective of the study is to evaluate the quality of care offered to adults through different models of care currently present.

Case Study of a Longstanding Online Community of Practice Involving Critical Care and Advanced Practice Nurses

The aims of this study are: to examine to what extent critical care and advanced practice nurses’participation in an online listserv constituted a community of practice, and to explore how the nurses use electronic media to communicate with one another. Findings suggest that the online listserv environment, as a whole, did function as an online community of practice, where participation not only served as an avenue for knowledge sharing situated in the actual context of the nurses’ everyday work experience, but also helped to reinforce identity of the nursing practice itself. [from abstrac

Community Impact of HIV Status Disclosure through an Integrated Community Home-Based Care Programme

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

Costing of the Integrated Management of Childhood Illnesses in Bangladesh: a Study Based on Matlab Data

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

Priority Service Provision Under Decentralization: a Case Study of Maternal and Child Health in Uganda

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization.

Satisfied Workers, Retained Workers: Effects of Work and Work Environment on Homecare Workers’ Job Satisfaction, Stress, Physical Health, and Retention

The goal of this project was to assist health system managers and policy makers develop policies and strategies to recruit and retain human resources in the homecare sector and have a satisfied, healthy workforce. Researchers worked in partnership with the agencies and the unions representing workers in the agencies to examine the effects of work and work environments on homecare workers’ emotional, mental, and physical health and intention to leave their workplaces. [executive summary]

Evaluating Teaching Effectiveness in Nursing Education: an Iranian Perspective

The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. [from abstract]

Participatory Supervision with Provider Self-Assessment Improves Doctor-Patient Communication in Rural Mexico

In this setting, physicians were already making site visits to clinics to monitor technical standards of care. An intervention was designed to reinforce doctors’ interpersonal communication (IPC) training. Under the intervention, doctors received IPC job aids, self-assessment forms, and tape recorders. They taped themselves during consultations and assessed their skills from the recordings, using the forms and in consultation with their supervisors. The self-assessment form and the supervisor assessment form were modified to be reproduced in this report. [publisher’s description]

Improving Provider-Client Communication: Reinforcing IPC/C Training in Indonesia with Self-Assessment and Peer Review

This study tested two low-cost alternatives to supervision-self-assessment and peer review-that may reinforce providers’ skills after training, in this case training in interpersonal communication and counseling (IPC/C). There were three study groups: the control group received no reinforcement after training, a “self-assessment” (SA) group performed SA exercises for 16 weeks after training, and a SA and peer review group also performed SA exercises for 16 weeks and met in small groups to peer review and guide each other in their efforts to improve their IPC/C skills.

Evaluation of an IMCI Computer-based Training Course in Kenya

The Quality Assurance Project (QAP) has developed and twice tested a computer-based version of the Integrated Management of Childhood Illness (IMCI) training course. Earlier testing had shown that the computer-based training (CBT), which takes six days, was as effective as the 11-day training traditionally used to teach healthcare providers to use IMCI. This report describes more recent testing of the CBT, which is available on CD-ROM.

Comparison of Computer-Based and Standard Training in the Integrated Management of Childhood Illness in Uganda

Facilitator-led training of 20 healthcare providers in IMCI requires 11 days of lectures/practice and 6 facilitators, while the QA Project’s computer-based training requires 9 days and 4 facilitators. This study compared the cost-effectiveness of the two methods and found that both courses had equal effects on participants’ knowledge and skills, and retention after three to four months. The computer course was about 25 percent less expensive, excluding the cost of developing the software and for the computers used in the training. [publisher’s description]

Application of Activity-Based Costing (ABC) in a Peruvian NGO Healthcare System

This paper describes the application of activity-based costing (ABC) to calculate unit costs for a healthcare organization in a developing country. It also describes the ways in which these calcualtions can provide information for improving the efficiency and quality of healthcare services. [from abstract]

Working With the Community for Improved Health

Sustaining healthy populations and creating a context that facilitates health may require a broader perspective, such as that embodied in community participation. But some health specialists think that community participation is time-consuming and does not really improve health outcomes. Participatory processes can be protracted and progress toward health goals delayed, requiring heavy time and resource investments that may not be matched by the achievement of desired results.

Positive Practice Environments: Key Considerations for the Development of a Framework to Support the Integration of International Nurses

This paper focuses on nurses who have migrated and are registered/licensed/authorized to practice, post-adaptation/orientation, and are working as a nurse in a given country. The term international nurse is used for nurses who have been educated abroad and have either been recruited or have chosen to migrate.

Business as a Partner in Strengthening Public Health Systems in Developing Countries: an Agenda for Action

This publication is part of a series that highlights some of the key challenges, opportunities and practical examples that were identified in dialogues among over 400 leaders in business, government, development agencies, civil society, and academia to share good practices and identify practical and feasible models of collective business action and public-private partnership aimed at achieving more systemic and scalable solutions to global challenges. It makes recommendations for ways that companies can get directly engaged in specific initiatives on-the-ground. [adapted from author]

Using Problem-Solving Teams to Improve Compliance with IMCI Guidelines in Kenya

The research described in this report investigated whether facility-based teams that had been trained and coached to develop and implement improvements in performance of the Integrated Management of Childhood Illness (IMCI) algorithm through problem-solving teams would improve case management. The study compared 21 facilities with teams and 14 without, all in rural facilities in Kenya.

Treating Tuberculosis in the Private Sector: Cambodia

The Quality Assurance Project undertook a national assessment of private sector tuberculosis (TB) services in Cambodia to improve understanding of private sector practices and the sector’s willingness to participate in efforts to improve TB services. Over 500 respondents, including doctors, pharmacists, drug sellers, and TB patients, participated. In addition, mystery shoppers visited private pharmacists and drug sellers so that the surveyed groups’ reports could be compared to actual experiences.

Safe Motherhood Studies: Timeliness of In-Hospital Care for Treating Obstetric Emergencies: Results from Benin, Ecuador, Jamaica, and Rwanda

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

Safe Motherhood Studies: Results from Rwanda: Competency of Skilled Birth Attendants; The Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

HIV/AIDS Crisis: How Are Businesses Responding?

As part of the African Growth and Opportunitues Forum, this paper addresses how African businesses are responding to the HIV/AIDS crisis. It is imperative that businesses take immediate action to lessen the economic and social consequences of HIV/AIDS. If they take action, businesses can ensure that economic initiatives, such as the African Growth and Opportunities Act (AGOA) will succeed in stimulating economic growth in Africa. While both the public and private sector should have HIV/AIDS policies and programs, this paper addresses only the private business sector response to the epidemic. However, many of the actions, best practices, and conclusions discussed in this paper are also applicable to public sector policies and programs.

Business Response to HIV/AIDS: Impact and Lessons Learned

This report aims to provide assistance to business and associated partners in recognising the business case for further action against HIV/AIDS in the workplace and beyond. This is achieved through providing evidence of the impact that HIV/AIDS has on business activities and by highlighting the lessons learned from past and current responses. Guidance is provided in the form of policy tools, case studies and an examination of how to undertake successful partnerships in response to HIV/AIDS. This publication does not seek to provide standard models but tools to guide effective, efficient and needs-specific responses to HIV/AIDS.

Observatory of Human Resources in Health

Even though the situation of human resources in health varies between the countries of the Region of the Americas, all of them are confronted by deep imbalances in the availability, composition, and distribution of the work force. These imbalances can be present as acute shortages of health personnel, chronic and persistent problems of inappropriate distribution of the work force with regard to needs, or inequities in composition of health providers in relation to the population served.

Impact of Supervision on Stock Management and Adherence to Treatment Guidelines: a Randomized Controlled Trial

Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers.

Western Pacific Country Health Information Profiles

The 2009 edition of CHIPS comprises the country profiles and the health databanks for each country and area of the WHO Western Pacific Region. It contains crude data that are supplied either by the health ministries/departments or compiled from national databases and reference libraries. Estimates and adjusted data from various published sources are also used. Every effort is made to update the figures and analyses in CHIPS annually in response to ever-growing demands for current data and information. Clearance by the respective governments is also sought prior to publication.

Safe Motherhood Studies: Results from Benin: Competency of Skilled Birth Attendants; the Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)

Through its Safe Motherhood Research Program, the Quality Assurance Project carried out three studies to explore issues regarding competence of skilled birth attendants, the elements that contribute to an enabling environment and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility in countries with high maternal mortality ratios.

Quality of Obstetric Care Observed in 14 Hospitals in Benin, Ecuador, Jamaica and Rwanda

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]