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Maina Boucar, MD, MPH USAID - Health Improvement Project University Research CO, Niger

Challenges and successes in maintaining gains in quality of care and institutionalizing quality improvement in Niger. Maina Boucar, MD, MPH USAID - Health Improvement Project University Research CO, Niger. Presentation Outline . What is institutionalization?

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Maina Boucar, MD, MPH USAID - Health Improvement Project University Research CO, Niger

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  1. Challenges and successes in maintaining gains in quality of care and institutionalizing quality improvement in Niger Maina Boucar, MD, MPH USAID - Health Improvement Project University Research CO, Niger

  2. Presentation Outline • What is institutionalization? • Context and process in Niger: How well have we institutionalized gains in quality of care and QI? • What have we learned and where do we go from here?

  3. Institutionalization • “Establish and maintain QI [and improvement results and practices] as an integral, sustainable part of a health system or organization, woven into the fabric of daily activities and routine” Silimperi et al, 2002 • How can we operationalize this definition and make progress towards it? • How can the national health system (facilities, district, regions, central MOH) own this process?

  4. Niger EONC Collaborative: focus, scale, and coverage GOAL: reduce maternal/ newborn mortality by strengthening local health systems to implement and scale up high-impact, evidence-based, maternal-newborn interventions SCALE: 52 health facilities (tertiary, district and peripheral maternities) COVERAGE: Monitoring 3,085 births per month (27% of all public facility births) INTERVENTION PERIOD: July 2006-December 2008 .

  5. Sustaining gains for active management of the third stage of labor (AMTSL) in 20 sites in Niger

  6. Specific objectives for achieving institutionalization Site level: • Ensure sustaining gains in quality of EON care and related QI activities • Ensure availability of essential resources for quality health care • Strengthen implementation of QI activities and application to new areas District and Regional level: • Strengthen (technical and organizational) capacity of higher levels of the health system to provide adequate support to health facilities National Level: • Create an enabling policy and strategic environment for implementation of QI at all levels of the health system

  7. Institutionalization of QI • Implementation of QI at site level: • During collaborative: 88% of QI tasks implemented; 6 months after: 85%; 20 months after: 71% • 12 of 20 sites applied QI to a new area on their own initiative after collaborative ended • Institutionalization enhancing activities • Mean percentage of institutionalization-enhancing activities implemented at each level • Variation seen across sites, districts and regions

  8. Lessons learned • The process of institutionalization must be integrated into the initial implementation plan • Build QI and institutionalization activities into existing structural and organizational opportunities (e.g., supervision, regular meetings, HIS) • Make use of local clinical staff as trainers and coaches for QI, as they can best understand how to integrate this into daily work

  9. Lessons learned (continued) • For institutionalization, it is important to not only focus on clinical activities, but also on managerial support and planning (needs a whole systems view) • Institutionalization needs to be a focus at the policy level and be integrated into subsequent strategies and health development plans

  10. Message for others • Leaving institutionalization “for later” will cost you more in the end • Institutionalization is the responsibility of those inside the system • As part of this work, we developed tools for measuring and frameworks for enhancing institutionalization – take them and improve on them!

  11. “Institutionalization is a journey, not an event”ThanksFull report can be accessed at www.hciproject.orghttp://www.hciproject.org/node/2126

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