Human Resources Management

IUD Training Site Assessment for Key Social Marketing Project, Pakistan

This IUD assessment tool provides performance standards for IUD provision based on type of visit-new client or revisit. It may be used as part of a programmatic performance improvement initiative, by the site or individual providers to self-assess or by external evaluators to assess achievement of the standards. Often, performance standards are used to affect change at multiple sites. [author’s description]

Integrating Best Practices for Performance Improvement, Quality Improvement, and Participatory Learning and Action to Improve Health Services: Guidance for Program Staff

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement, quality improvement, and participatory learning and action.

Improving Performance to Maximize Access and Quality for Clients

The goals of this presentation include introducing the performance improvement (PI) approach, framework and factos influencing performance; how PI works; and the benefits of using PI. [adapted from author]

Toolkits for Strengthening Primary Health Care

In Albania, the PHRplus Project developed and tested a series of tools designed to introduce family medicine concepts and strengthen primary health care (PHC) services. PHC facility managers will find the toolkits useful reference materials when developing strategies and tools to improve quality of care and monitor and evaluate PHC strengthening efforts. This series comprises three toolkits: PHC Service Delivery Toolkit; PHC Quality Improvement (QI) Toolkit; and PHC Health Information Systems (HIS) Toolkit. [from abstract]

Managing Performance Improvement of Decentralized Health Services

This issue of The Manager will help managers at all levels understand the principles of local-level performance assessment and improvement. It also presents the concept of essential public health functions as a useful policy framework for decentalizing service management while maintaining and improving the coverage and quality of services. [editor’s description]

Competency Development in Public Health Leadership

As the complexity of the challenges facing the public health workforce has increased, many have argued that insufficient resources have been devoted to the preparation of the workforce, including its leaders. Here we describe the growth of national advocacy for public health leadership and workforce development.

Checklists Reduce Medical Barriers to Contraceptive Use

Contraceptive provision in many settings continues to be based on outdated medical information, unproven theoretical concerns, and provider biases. Studies have found that in some developing countries 25-50% of women seeking contraceptives are refused services until they are menstruating. Coupled with effective training, checklists can be important tools for health care workers at various levels to apply the latest WHO medical eligibility criteria and guidelines for contraceptive use.

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]

Compliance, Workload, and the Cost of Using the Integrated Management of Childhood Illness Algorithm in Niger

This study examines the relationship between IMCI compliance and three cost issues: the length of client-provider consultations, treatment drugs, and workload. The setting was 26 health clinics in Niger, the only developing country setting where QA was implemented before IMCI. [publisher’s description]

Practice of Physicians and Nurses in the Brazilian Family Health Programme: Evidences of Change in the Delivery Health Care Model

The article analyzes the practice of physicians and nurses working on the Family Health Program. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams’ work agenda to their routine labour activities. [abstract]

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.

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]

Improving the Performance of the Health Workforce: from Advocacy to Action

This speech contends that a well performing workforce is the most critical determinant of the performance of services. Well functioning infrastructures and equipment do not serve if the people who deliver the services are not there (be it that there are none available, that they are absent from work, or that they are on strike). Well trained health workers, without the appropriate tools and supplies cannot do much either. And even when all ingredients are there, if workers are not motivated, services underperform. Advocacy to convince policy and decision-makers, as well as international agencies and donors to do something to improve the performance of the health workforce (HW) has been fervent these last 3-4 years, and it has been quite successful.

Improving Health Workforce Performance

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

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]

Improving the Management of Obstetric Emergencies in Uganda through Case Management Maps

Case management maps (CMMs) are a type of job aid: a sheet of paper with information that guides healthcare providers in treating patients. Each patient has his or her own condition-related CMM, which is maintained in the patient’s chart or on the wall near the patient’s hospital bed to inform providers of the treatment protocol, what treatment was provided when and by whom, what to do should a critical event occur, etc. This report describes a study that implemented two CMMs that were introduced about a year apart in a 500-bed hospital where such job aids had not previously been used.

Impact of Self-Assessment with Peer Feedback on Health Provider Performance in Mali

This study sought to better understand how to sustain provider compliance with standards, using local (Mali) standards (on care for fever and structural quality). The intervention had two parts: a self-assessment instrument that providers used weekly to assess their performance with a feverish client and a review of that performance by a colleague who had observed the consultation. The study found that when used regularly, such an intervention can have a significant effect on compliance.

Impact of QA Methods on Compliance with the Integrated Management of Childhood Illness Algorithm in Niger

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams.

Quick Investigation of Quality (QIQ): a User's Guide for Monitoring Quality of Care in Family Planning

This user’s guide contains materials needed to design and implement the Quick Investigation of Quality (QIQ) in a given country. QIQ refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs. This volume includes an overview of the QIQ (including objectives, short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection and summary results from short list of indicators (tabular and graphic forms).

Performance Improvement

Performance lmprovement (PI), a process pioneered in industry, is now helping to strengthen reproductive health organizations. PI focuses on meeting the needs of service providers and other staff members. When programs enable and inspire staff to do their best, the quality of care improves. [author’s description]

This Population Report covers how to: define desire performance, describe actual performance, measurs/describe performance gaps, find the root causes, select and implement interventions, monitor and evaluate performance and manage change.

Sustaining Quality of Healthcare: Institutionalization of Quality Assurance

This monograph presents a conceptual framework to help healthcare systems and organizations analyze, plan, build and sustain efforts to produce quality healthcare. The framework synthesizes more than ten years of QA Project experience assisting in the design and implementation of QA activities and programs in over 25 countries. [author’s description]

Assessing the Functionality of Job Aids in Supporting the Performance of IMCI Providers in Zambia

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card.

Quality Assurance of Health Care in Developing Countries

This monograph provides an introductory overview of QA for developing countries. It will be of interest to policy makers, upper-level ministry of health (MOH) officials, and district-level health service managers. Part I describes how quality assessment and improvement have been carried out in less developed countries (LDCs). Part II discusses the feasibility and rationale for applying QA in the developing world. Part III proposes some definitions and dimensions of quality. Part IV reviews the definition and basic tenets of QA.

Team Players: Building the Skills of Local Health Care Planners

Training and innovative tools were key to the success of the Tanzania Essential Health Interventions Project, along with small funding increases. The tools and strategies allowed the districts of Rufiji and Morogoro to target their new resources on the largest contributors to the burden of disease and on health care delivery. The most dramatic result, among many, has been an average decline in child mortality of more than 40%. [from author]

Costs of Reproductive Health Services Provided by Four CHAG Hospitals

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

Maintenance of Competence of Rural District Hospital Medical Practitioners

The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and, most acutely, by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa. The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. [author’s description]

Technical Review of Health Service Delivery at District Level

The 2003 technical review report covers only one main strategy: district health services. It looks at district health service performance from the viewpoint of Council Health Management Teams (CHMT) and LG. The report presents a short general appraisal of district health services (section 1). Planning and budgeting for better health (section 2) looks at what the requirements are for a performing planning and budgeting process (section 2.1, including guidelines and process) and what information should be available at council level to develop a comprehensive council health plan (section 2.2). Issues related to implementing the council health plan (section 3) include financial resources (3.1), non-financial resources (3.2), systems development (3.3) and service delivery (3.4).

Study of Health Workers' Knowledge and Practices Regarding Leprosy Care and Control at Primary Care Clinics in the Eerstehoek Area of Gert Sibande District in Mpumalanga Province, South Africa

A successful leprosy care and control program within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of, and practical training on, leprosy. This study describes PHC workers’ knowledge of leprosy, and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa, where leprosy still occurs. [author’s description]