Evaluating Quality Improvement Initiatives Supported by Growth through Nutrition
The Government of Ethiopia has placed substantial emphasis on improving quality of health services. This has led to the adoption of a national policy on healthcare quality and the introduction of several initiatives that intend to improve quality of health services provided at all levels of the health system. Growth through Nutrition (GTN), a 5-year USAID Feed the Future nutrition project in Ethiopia, has been providing technical and financial support for quality improvement on nutrition interventions within Primary Health Care Units (PHCU), ensuring availability of nutrition commodities, and data use for evidence-based decision-making processes for program refinement. In August 2019, the project has progressively reached 551 PHCUs to support increased uptake of nutrition services by mothers and young children, out of which 101 model Health Centers (HC) and one Health Post (HP) under their respective catchment were selected and supported to apply QI models. This study intended to assess the role of quality improvement initiatives in improving nutrition interventions at PHCU level and identify challenges and facilitators of implementation to facilitate learning.
The study employed a cross sectional study involving both quantitative and qualitative methods supplemented by secondary analyses of Quality Improvement (QI) project data to assess the level of implementation of QI processes, the extent to which QI projects have brought actual improvements, and barriers/facilitators for implementation of QI activities.
Sample size was determined using LQAS technique. The sample included 22 randomly selected PHCUs implementing quality improvement under the support of the project in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia.
Quantitative data was obtained primarily by reviewing quality improvement documents. Qualitative data was collected through key informant interviews and focus group discussions at health post (HP), health center (HC), and Woreda Health Office levels.
STATA version 14 and OpenCode Qualitative Data Management Software were used to assist in quantitative and qualitative data management/analyses, respectively.
Quality improvement models have been effectively introduced in project supported PHCUs. Institutionalization is however in its early stage. While Kaizen was implemented in both HC and HP settings, implementation of MFI has been mostly limited to HCs. MFI projects in HCs were in general effective in improving targeted nutrition interventions; however, there were several ineffective projects suggesting gaps in root cause analyses and intervention development among HC level QI teams and inadequate capacity at HP level. Facilitators and barriers to implementation of QI models include but are beyond technical capacity of individual health workers.
Continued support is needed to ensure sustainable implementation of QI processes in target HCs and HPs. It is important to strengthen support from the project as well as supervising institutions with a strong component to monitoring progress of each facility in implementing components of applied QI models. Linking processes of Kaizen with MFI and developing simplified approach for implementation of MFI at HP level should be priorities for further adaptations of the models in the future.