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Ghana
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Improved overall knowledge in tasks performed by Community Health Officers through observations and responses to questions
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Emergency referral project - increases access to care, pushes services to community level [43]
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Improved data literacy skills among health workers
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Health workers invested in scaling up program [42]
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Staff turnover, not strong M&E, difficult to stick to planned check-ins
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Mozambique
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Median data concordance improved from 56% between 2009 and 2010 (baseline period) to 87% at the end of the intervention (2012–2013) [26].
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Better understanding of data, increased ownership, increased recognition of the importance of data sharing/feedback
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Strong government involvement at all levels of the provincial health system, leads to more accountability and ownership, and better oversight by system managers
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Low baseline computer and data analysis skills among front-line staff; conflicting priorities among limited number of provincial managers; difficulties in supporting (financially/logistically) facility and district action plans
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Rwanda
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Used pre/post-tests to assess knowledge changes and retention over time [district reports]
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Increase in correct danger sign assessment in IMCI visits (from 47% to 99.8%) [27]. And increase in correct diagnosis from 56% to 91 [54].
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Better data literacy among providers and mentors. Improvement in data quality [55]
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Coaching leads to interactive, collaborative capacity building, active listening and relationships, support (not policing), real-time feedback that lead to increased motivation [55].
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High demand for M&E support (data entry, analysis, reporting), difficult to stick to quarterly schedule, high turnover of health center staff, poor health facility infrastructure, logistical challenges (transport) limited mentoring time
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Tanzania
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Conducted evaluation of training program to identify processes that could be improved, found that correct IMCI diagnosis was satisfactory
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Quality of care was ensured through measurements of correct diagnosis and treatment of under-5 illness by WAJA. 73% of 300 WAJA consultations were correctly diagnosed as measured against an IMCI-trained medical professional. 84% of 86 children diagnosed with malaria were treated correctly by WAJA.
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Both clinical supervisors and WAJA cite their relationships as intrinsic motivators for better performance
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Village CHW supervisors did not feel adequately compensated, tension because they were volunteers v. paid CHW. Challenges in ensuring visits to CHW from facilities.
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Zambia
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Improved patient-provider interaction, better outcomes, improved clinical judgement/case management, improvement in management of malaria according to protocols.
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Increased use of Electronic Medical Record system, increases in data use and feedback [38].
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Local ownership and collaboration, increased trust from clinical workers of QI teams, increased support for work load [38].
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Shortage of qualified staff, MoH staff/volunteer attrition, poor health facility infrastructure, misunderstanding of mentor’s role by mentee, resistance to change
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