Quality improvement and CHW performance: a mixed method research study Dr Lilian Otiso LVCT Health, Kenya 1 Innovating for Maternal and Child Health in Africa (IMCHA): Training for Implementation Research Teams. Southern Sun Hotel, Nairobi 17 th December 2015 Aim and objectives Aim: To maximize the equity, effectiveness and efficiency of CTC services in rural areas and urban slums in six countries: Mozambique, Indonesia, Kenya, Malawi, Bangladesh and Ethiopia. 2 A unique platform Works with range of CHWs Across different country contexts over time rural and urban Research that goes beyond single disease programmes a health systems approach Innovative methods Building capacity for embedded research on CTC providers Monitoring different outcomes maternal and child health, TB, HIV. 3 In a nutshell Context analysis Quality improvement Quality embedded Improved equity, effectiveness and efficiency of CTC services 1. Build capacity in health systems research 2. Identify influence of context, policy and health system 3. Develop and assess interventions 4. Inform evidence based, context appropriate policy making Multiple methods 4 Context analysis 5 Context analysis framework 6 Common areas for QI CountryFocus areas BangladeshSupervision Referral EthiopiaSupervision Referral Pregnant women forum + health development army leaders meeting KenyaSupervision Community dialogue days IndonesiaSupervision Community engagement Health promotion MalawiSupervision Performance (best practice) MozambiqueSupervision (Referral) 7 QI Cycle 8 Mixed Methods QI cycle 9 Mixed methods research Three main types used: Exploratory context analysis Explanatory - motivation questionnaires and IDIs Triangulation Influence of supervision on performance of CHWs program assessment, questionnaires, IDIs and FGDs & Observation, QI tracking and referral tracking Inter-country analyses 10 Pitfalls of mixed methods research OCathain(2008) Draft baseline reports highlighted gaps in the mixed methods research Reported components separately Lack of understanding of why the different components of MMR No attempt to integrate data Emphasis on one form over the other 11 Capacity building Young researchers training on mixed methods research Peer review of reports Country level f/up training for various components e.g. quantitative 12 Mixed methods research training 13 Key results Supportive supervision was confirmed to be motivating and improving CTC performance (quant and qual findings). Peer approaches also worked (Ethiopia) QI tracking - frequency of meetings (observed) not as regular as reported. Variation in quant and qualitative in Kenya Post training f/up supervisors did not apply the skills learned (Indonesia, Bangladesh) Increased community engagement and CTC training increased linkage and ANC forum attendance (Ethiopia and Indonesia) Referral tracking revealed gaps in data quality and flow 14 Next steps: Embedding QI REACHOUT is an unique opportunity for analysis within and between countries on what works, for whom and where Our QI approaches have been successful but are not sustainable on their own The challenge now is to move from researcher led to district led systems that assure the quality of community health This requires a culture shift in the thinking of national programmes, donors, vertical projects. 15 Embedding: needs local ownership 16 Universal Health Coverage & Quality Everyone has access to quality health services that they need without risking financial hardship from paying for them. Need to ensure basic standards of quality of care Motivate providers and professionals to improve Activate patient and public demand for quality "UHC focused solely on expanding access and NOT simultaneously addressing quality will have limited impact on population health HLSP Summary Brief, June 2014 "UHC focused solely on expanding access and NOT simultaneously addressing quality will have limited impact on population health HLSP Summary Brief, June + 18 Acknowledgements EU funding Dr Miriam Taegtmeyer, LSTM - coordinator REACHOUT Team Governments of Kenya, Malawi, Ethiopia, Mozambique, Indonesia, Bangladesh Close to community providers 19 Find out more Visit us onFollow usPapers in thematic series on close-to-community providers in Human Resources for Healththematic series on close-to-community providers Join the Thematic Working Group at Health Systems Global, contact Faye Moody 20 21THANK YOU!