Quality Improvement and Clinical Governance Initiative - Piloting Quality Improvement Packages in Primary Care Centers Impact Evaluation 2014-2016

Baseline & Follow-up Surveys

While maternal, neonatal, and child health (MNCH) outcomes are improving in Nigeria, the rate of improvement is not sufficient to meet the MDGs related to child and maternal health. Nigeria’s under-5 mortality rate, estimated to be 124 deaths per 1000 live births in 2012 is one of the highest in the World. In fact, UNICEF (2012) ranked Nigeria as the country with the 12th highest under 5 mortality rate in the world. The Nigerian Federal Ministry of Health (FMOH) is addressing these challenges by introducing important reforms and is committed to learning which of these are working and worth scaling up. Evidence on the causal impact of past and ongoing quality improvement programs is, however, lacking, and so the scope for using previous experience to reliably guide future policy and program design is limited. Assessing and improving the quality of healthcare delivery in developing countries has been recognized as a priority by the WHO and other health agencies (WHO 2006; Institute of Medicine, 2001).

In this context, the Nigerian Federal Ministry of Health proposes to experimentally evaluate variants of a healthcare management consulting intervention to enhance the quality of health care, especially maternal, newborn, and child health care. The consulting program studied in this IE aims at improving service quality and patient safety at primary healthcare centers (PHCs) by relaying information to providers and through mentoring and tutelage. Service quality and patient safeties are systemic healthcare challenges throughout Nigeria and the broader region. The goal is to impact provider knowledge and behavior, improving effort, and ultimately health outcomes, patient safety and patient satisfaction. This program is implemented jointly by the Ministry and the National Primary Healthcare Development Agency (NPHCDA).

As data sources to measure and quantify the impact, the IE will use a combination of PHC administrative data, facility-level survey data, the tools developed by the healthcare consulting firm, the SDI and SURE-P surveys, as well as additional instruments to assess the quality of care.

• The Service Delivery Indicators (SDI) is an initiative by the World Bank, in partnership with the African Economic Research Consortium and the African Development Bank, that collects data on service delivery in schools and health facilities across Africa.

• The SURE-P MCH Program is an ambitious initiative to tackle key supply and demand-side constraints to the effective delivery of maternal and child health services in order to improve Nigeria’s MCH outcomes. SURE-P MCH will incorporate a set of four IEs looking at various pre-identified supply and demand-side challenges. The SURE-P baseline data collection was carried out in September and October of 2013. All 80 clinics of the QE project were featured in this data collection. From this data, information on facility characteristics and staffing details are being reflected in this report.

• As part of the quality improvement program, the healthcare management consulting firm Pharm Access Safe Care conducted a baseline quality of care assessment in the 48 clinics that comprise treatment groups A and B. The baseline assessment included 829 indicators (of which not all are applicable to the QE context). For the 24 clinics of Treatment Group A (“full treatment”), the firm also created “Quality Improvement Plans” (QIPs).

In order to track progress over time and in order to increase the statistical power of the study, the research team decided to conduct a monthly high-frequency data collection (HFDC) as a follow up instrument