Scaling up Standards-based Management and Recognition approach to improve quality of primary health care services in Pakistan: Achievements and challenges

Background

Districts of Bagh (AJK) and Manserha (NWFP) were affected by the Pakistan earthquake in 2005. An estimated 87,000 lives lost 3.5 million left homeless and populations unable to access adequate primary health care (PHC) services. The Primary Healthcare Revitalization, Integration and Decentralization in Earthquake affected areas (PRIDE) project began in 2006 focusing on improving health outcomes in 2 districts funded by USAID. PRIDE uses the Standards-based Management and Recognition (SBMR) approach for improving quality of services.

Purpose

To discuss achievements and challenges in improving PHC services with SBM-R approach in 14 PHC performance areas.

Methods and Analysis

Baseline data was collected in 29 facilities in June 2007 with a follow-up assessment in January 2008 (after six months of interventions in infection prevention, focused antenatal care, family planning, and child immunization). Direct observations, demonstrations, and interviews were used for baseline and follow-up assessments using the SBM-R assessment tools.

Results

In Mansehra, performance improved from baseline (14%) to (44%) at 6 months; in Bagh performance improved from 17% to 27%, respectively. In the four focused clinical areas remarkable improvement were seen in Mansehra (15% vs. 69%) and Bagh (19% vs. 52%).

Conclusions

SBMR allows consensus building on performance standards based on evidence and best practices. It also facilitates decision making by providing performance data for each facility. Coaching and involvement of staff in the quality improvement process, introduces a culture which recognizes higher performers. Project is addressing challenges of scaling up like shortage of female staff, maintaining quality of on-job coaching, and low utilization of health facilities.