Using the Collaborative Approach to improve Pediatric Hospital Care in developing countries

Background:

Many programs to reduce child mortality have often ignored district hospitals, where seriously ill children are taken yet quality of care is often poor. In 2003-2004, the Quality Assurance Project began supporting health ministries in Nicaragua, Niger, and Tanzania to improve the quality of care for hospitalized children through national Pediatric Hospital Care Improvement (PHI) collaboratives. The goal of the PHI collaboratives was to adapt WHO guidelines to local conditions and then scale up the application of these guidelines through quality improvement teams in participating facilities, which initially included 6 hospitals in Nicaragua, 17 in Niger, and 5 in Tanzania. At the start of each collaborative, teams self-assessed their care and then began introducing site-specific improvements. Over two years, teams met 4-5 times in 2-day workshops to acquire new knowledge and skills and share experiences in implementing changes and received periodic coaching visits by local experts.

Results: Teams have implemented numerous systems improvements, including setting up emergency triage assessment and treatment systems in all participating facilities and putting in place procedures for monitoring compliance with standards of care. Compliance with pneumonia standards has risen from below 20% to over 80% in all three countries; some reductions in case fatality have been documented.

Conclusions: The collaborative approach is an effective way to introduce standards of care, apply them and rapidly increase compliance with these standards. The PHI collaboratives also helped to coordinate key partners at national and district levels, a process which contributes to institutionalization of evidence-based standards of care.