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Use of facility-based assessments

for decision-making in UgandaBy Peter Waiswa

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EQUIP Expanded Quality

Management Using Information

Power to improve maternal and

newborn health

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Main objective of EQUIP

To assess the feasibility, cost and community

effectiveness of an innovative approach of ExpandedQM Using Information Power (EQUIP) that l inks

communities and health facilities to increase the quality

and uti lization 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 tocommunity

Assess feasibility and effects Analyse costs and cost-effectiveness

Engage with policy makers continuously

Project also done in Tanzania

Funded by the EU

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Use of continuous health

facility survey data To show whether intervention district has

evidence of improved quality andincreased utilisation of health services.

Data is linked to drive a QI process atfacilities; management and support by thedistrict health team; and for advocacy for

newborn interventions and improvedcommodity availability

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Equip project

Quarterly data collection in all health facilities intwo districts

District Nov 11 Feb 12 Apr 12 J uly 12Oct 12 Feb 13Mar 13 J un 13 Aug 13 Nov13J an 14 Apr 14Mayuge 38 38 38 - - -

Namayingo 22 22 22 - - -

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Fora for data use

Health facility in charge convenes monthlyQI meetings at health facilities with healthworkers and district mentors as facilitators

Quarterly learning sessions of healthworkers with community involvement anddistrict mentors

District health teams meetings to reviewlower level experiences and report card

Regular update of Ministry of Health inmaternal, newborn and child cluster

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

20

6

11

79

8783

3638

43

8 5 7

2118

31

0

10

20

30

40

50

60

70

80

90

100

Nov 11 Feb 12 Apr 12 J uly 12 Oct 12 Feb 13

Distr ict Report Card:Health Facil i ty Preparedness

to Provid e Care to pr egnant wo men

Prepared all essential items Used a partograph Blood pressure measured

urine tested syphillis test results

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5 8 8

68

82 82

5 5 50

10

20

30

40

50

60

70

80

90

100

Nov 11 Feb 12 Apr 12 J uly 12 Oct 12 Feb 13

Distr ict Report Card:Health Facil i ty Preparedness

to Provi de Care to Mothers and Newbor ns

Anti-infective drugs Person trained in newborn care Transport for referral

Anti-infective drugs for maternity care means that there was ampicillin,

gentamicin, benzyl penicillin, and tetracycline in stock.

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Quality Improvement: Proportion of women who have delivered in facility

and come back for PNC within the first week after delivery, Mayuge

District

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Outcomes of this decision

making process

QI scaled up in entire district at communityand facility level

Used data to demand for more maternal

and newborn drugs to the district fromNational Medical Stores

Was able to mobilise NGO support to train

health workers Advocacy for MNCH equipment

Staff transfer within the district (midwives)

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Lessons learned from this

process Use of data from continuous HF surveys

can be a basis for health systemimprovement for maternal and newborn

health (QI, advocacy, engagement)

Data availability in itself is not a means toan end. Users must be trained and

facilitated/motivated to use the data

Need to focus on a few relevant andsimple indicators

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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 usedproductively

Participation of managers (in-charges andDHO) important for the system to besustained

Hawthorn effect (being watched saythrough mentoring/supervision) is critical

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Partners

IHCAR/KI, PI Stefan Peterson

Makarere University, Uganda

Ifakara Health Institute, Tanzania

LSHTM, UK

EVAPLAN, Germany

Timeline: 4 years, started Nov 2010