Use of facility-based assessments for decision-making in Uganda By Peter Waiswa

EQUIP Expanded Quality Management Using Information Power to improve maternal and newborn health

Main objective of EQUIP

To assess the feasibility, cost and community effectiveness of an innovative approach of Expanded QM Using Information Power (EQUIP) that links communities and health facilities to increase the quality and utilization of health care services in order to improve maternal and newborn health in rural Uganda
On going project in 2 districts since November 2011 Collect health data and summarise into report cards Implement quality management at health facility and district level, extended to community Assess feasibility and effects Analyse costs and cost-effectiveness Engage with policy makers continuously Project also done in Tanzania Funded by the EU

Use of continuous health facility survey data

To show whether intervention district has evidence of improved quality and increased utilisation of health services. Data is linked to drive a QI process at facilities; management and support by the district health team; and for advocacy for newborn interventions and improved commodity availability

Equip project
Quarterly data collection in all health facilities in two districts

District
Mayuge

Nov 11 Apr 12 Oct 12 Mar 13 Aug 13 Jan 14 Feb 12 July 12 Feb 13 Jun 13 Nov13 Apr 14

38

38

38

Namayingo

22

22

22

Fora for data use

Health facility in charge convenes monthly QI meetings at health facilities with health workers and district mentors as facilitators Quarterly learning sessions of health workers with community involvement and district mentors District health teams meetings to review lower level experiences and report card Regular update of Ministry of Health in maternal, newborn and child cluster

District Report Card: Health Facility Preparedness to Provide Care to pregnant women
100 90

87 83 79

80

70

60

50

43
40

36
30

38 31

20

21 20 8
Nov 11 Feb 12 Prepared all essential items urine tested

18 6 5
Apr 12 July 12 Used a partograph syphillis test results

10

11 7
Oct 12 Feb 13 Blood pressure measured

. Preparation of all essential items means that the following had been prepared: gloves, disinfectant, gauze, cloth, scissors, ligature, oxytocin/ergometrine and eye ointment

District Report Card: Health Facility Preparedness to Provide Care to Mothers and Newborns
100 90 80 70 60 50 40 30 20 10

82 68

82

5
0

8 5 Apr 12 July 12
Person trained in newborn care

8 5 Oct 12 Feb 13
Transport for referral

Nov 11 Feb 12
Anti-infective drugs

Anti-infective drugs for maternity care means that there was ampicillin, gentamicin, benzyl penicillin, and tetracycline in stock.

Quality Improvement: Proportion of women who have delivered in facility and come back for PNC within the first week after delivery, Mayuge District

Outcomes of this decision making process

QI scaled up in entire district at community and facility level Used data to demand for more maternal and newborn drugs to the district from National Medical Stores Was able to mobilise NGO support to train health workers Advocacy for MNCH equipment Staff transfer within the district (midwives)

Lessons learned from this process

Use of data from continuous HF surveys can be a basis for health system improvement for maternal and newborn health (QI, advocacy, engagement) Data availability in itself is not a means to an end. Users must be trained and facilitated/motivated to use the data Need to focus on a few relevant and simple indicators

Lessons learned from this process

Most of the needed data is available and almost limited cost of collection Team work critical for data to be used productively Participation of managers (in-charges and DHO) important for the system to be sustained Hawthorn effect (being watched say through mentoring/supervision) is critical

Partners
IHCAR/KI, PI Stefan Peterson Makarere University, Uganda Ifakara Health Institute, Tanzania LSHTM, UK EVAPLAN, Germany

Timeline: 4 years, started Nov 2010