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Table 4 Specific interventions for improving quality in selected areas in the PHIT programs

From: Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

Country Area of focus as described by Partnership (main WHO building block)* Interventions
Ghana [12] Information management (I, MVT) Implementation of a “simplified register” that condenses the volume of registers that workers manage each month from 28 to five, greatly reducing the burden of data capture and simplifying the process of information reporting.
Development and implementation of a District Health Planning and Reporting Toolkit
Utilization of simplified logistic monitoring tools to strengthen capacity to monitor status of supply readiness at service delivery points.
  Logistics gap (MVT) Employment of simple logistics monitoring tools developed in Nkwanta district for the PHIT-supported initiative to allow district teams monitor supply readiness at all service delivery points.
  Leadership capacity (LG) Leadership and management training to build capacity of district and sub-district managers to better manage and supervise frontline healthcare personnel; utilize data for decision making, and strengthen planning and decision making for resource allocation.
  Evidence-based resource allocation and other decision making (LG) Management training to ensure utilization of the District Health Planning and Reporting Toolkit and other data for decisions and resource allocation.
Mozambique [16] Improved systems and quality of care (I, LG) Improved data-driven decision making capacity through: development of appropriate tools to facilitate decision-making for provincial and district managers (quarterly report card/data dashboard that provides longitudinal comparisons of key PHC indicators across all facilities within a district and across all districts within the province); strengthening of data-driven decision making through
capacity-building in management and leadership including linking data with annual planning, and combination of in-service trainings and post-training coaching focusing on problem identification, solution generation, implementation, and assessment; applied research to understand and/or test innovations to overcome bottlenecks.
  Human resource allocation (HW) Development of a simple optimization model to simulate and improve human resource allocation.
  Data systems, data quality and feedback loop (I) Regular assessment including DQAs of availability, consistency, accuracy and validity of data for key primary health care system
Monthly review by district staff for data quality with rapid feedback to address gaps.
Rwanda [10] Quality of clinical care and supervision (HW) Training of Heath center nurses followed by ongoing mentoring and enhanced supportive supervision (MESH) from nurse mentors. Mentors also help identify and address system barriers to care through coaching in quality improvement.
  Data quality and utilization (I, LG) Partnership with the MOH to perform DQAs with support ongoing to address and improve data quality.
Support of district, facility and community heath staff to utilize data through training, reports development and other decision aids (e.g. dashboards).
  Infrastructure and supplies (SD, MVT) Provision of infrastructure support based on measured gaps between existing resources and MOH guidelines at the health center with follow-up monitoring.
Strengthening of district pharmacy and ongoing monitoring and feedback on stock-outs and equipment gaps.
Tanzania [11] Equity of access to and receipt of needed services (SD) Training and deploying of Community Health Agents to deliver community-based reproductive, maternal, newborn and child health promotion services as an integrated package of community-based primary care.
  Supervision and governance (LG) Strengthening supervisory systems and community governance mechanisms.
  Referral systems (SD) Development and implementation of a referral system through training and infrastructural improvement to improve accessibility.
  Information systems and utilization (I, MVT) Launch of information and monitoring operations and implementation of logistics support systems.
Zambia[8] Quality of clinical care (SD, HW) Training and intensive clinic mentoring by district clinical quality teams
Implementation of practical tools that establish clear clinical care standards supported by initial training and mentoring.
  Supervision (SD, HW) Supportive reinforcement of the standards through ongoing supervision and mentoring by the district clinical quality team.
  Resources (MVT) Ensuring sufficient resources including medicines and equipment needed to deliver care according to standards.
  Data utilization (I) Implementation of a performance feedback loop based on information from clinical management tools. Clinic performance measurement reports are produced and in use by QI teams to support clinician and health center mentoring and supervision and identify health system gaps contributing to lower performance.
  Community participation in health (SD) Training and deployment of community health workers with skills to promote available services at the facilities and adherence to recommended care and to recognize danger signs and make timely referrals
Measurement of community perceptions of appropriate governance.
  District capacity for quality measurement and supervision (SD,MVT,LG) Supporting district-based staff, including the QI teams, a community coordinator, and a pharmacy technician.
  1. *SD: Service delivery; HW: Health workforce; I: information; MVT Medical Products, Vaccines, & Technologies; F: Financing; LG: Leadership and Governance