Browsing by Author "Wagenaar BH"

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Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia.
(2017-Dec-21) Wagenaar BH; Hirschhorn LR; Henley C; Gremu A; Sindano N; Chilengi R; Health Alliance International, Seattle, WA, USA.; Department of Global Health, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. wagenaarb@gmail.com.; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Health Alliance International, Beira, Mozambique.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Partners in Health, Kigali, Rwanda.; Health Alliance International, Seattle, WA, USA. wagenaarb@gmail.com.; Department of Global Health, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation's African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. This paper describes the similar and divergent approaches to increase data-driven quality of care improvements (QI) and implementation challenge and opportunities encountered in these three countries. METHODS: Eight semi-structured in-depth interviews (IDIs) were administered to program staff working in each country. IDIs for this paper included principal investigators of each project, key program implementers (medically-trained support staff, data managers and statisticians, and country directors), as well as Ministry of Health counterparts. IDI data were collected through field notes; interviews were not audio recorded. Data were analyzed using thematic analysis but no systematic coding was conducted. IDIs were supplemented through donor report abstractions, a structured questionnaire, one-on-one phone calls, and email exchanges with country program leaders to clarify and expand on key themes emerging from IDIs. RESULTS: Project successes ranged from over 450 collaborative action-plans developed, implemented, and evaluated in Mozambique, to an increase from <10% to >80% of basic clinical protocols followed in intervention facilities in rural Zambia, and a shift from a lack of awareness of health data among health system staff to collaborative ownership of data and using data to drive change in Rwanda. CONCLUSION: Based on common successes across the country experiences, we recommend future data-driven QI interventions begin with data quality assessments to promote that rapid health system improvement is possible, ensure confidence in available data, serve as the first step in data-driven targeted improvements, and improve staff data analysis and visualization skills. Explicit Ministry of Health collaborative engagement can ensure performance review is collaborative and internally-driven rather than viewed as an external "audit."
Tackling the hard problems: implementation experience and lessons learned in newborn health from the African Health Initiative.
(2017-Dec-21) Magge H; Chilengi R; Jackson EF; Wagenaar BH; Kante AM; Health Alliance International, Seattle, WA, USA.; Partners In Health, Kigali, Rwanda. hmagge@ihi.org.; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA. hmagge@ihi.org.; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.; Partners In Health, Boston, MA, USA. hmagge@ihi.org.; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. hmagge@ihi.org.; Department of Global Health, University of Washington, Seattle, WA, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. METHODS: Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes in health systems strengthening intervention strategies used to target improvement in newborn health, which were incorporated by all PHIT projects with varying results: health service delivery at the community level (Tanzania), combining community and health facility level interventions (Zambia), participatory information feedback and clinical training (Ghana), performance review and enhancement (Mozambique), and integrated clinical and system-level improvement (Rwanda), and used individual case studies to illustrate each of these themes. RESULTS: Tanzania and Zambia included significant community-based components, including mobilization and sensitization for increased uptake of essential services, while Ghana, Mozambique, and Rwanda focused more efforts on improving the quality of services delivered once a patient enters a health facility. All countries included aspects that improved communication across levels of the health system, whether through district-wide data sharing and peer learning networks in Mozambique and Rwanda, or improved referral processes and systems in Tanzania, Zambia, and Ghana. CONCLUSION: Key lessons learned include the importance of focusing intervention components on addressing drivers of neonatal mortality across the maternal and newborn care continuum at all levels of the health system, matching efforts to improve service utilization with provision of high quality facility-based services, and the critical role of leadership to catalyze improvements in newborn health.