221788 Evaluation of a national quality improvement initiative in infection prevention and reproductive health services in Malawi

Monday, November 8, 2010 : 2:50 PM - 3:10 PM

Aleisha Rozario, MPH , Jhpiego, Lilongwe, Malawi
Barbara J. Rawlins, MPH , Jhpiego, Johns Hopkins University, Washington, DC
Young-Mi Kim, EdD, MS , Jhpiego, Johns Hopkins University, Baltimore, MD
Tambudzai Rashidi, MSc , Jhpiego, Lilongwe, Malawi
Sheila Bandazi, MPH , Nursing Services, Reproductive Health Unit, Malawi Ministry of Health, Lilongwe 3, Malawi
Fannie Kachale, MSc , Reproductive Health Unit, Malawi Ministry of Health, Lilongwe 3, Malawi
Background: Jhpiego and the Malawi Ministry of Health (MoH) applied a Performance and Quality Improvement (PQI) intervention to strengthen reproductive health (RH) services at 16 district hospitals, all 4 central hospitals, and 12 health centers in Malawi. They also implemented a PQI intervention for infection prevention (IP) at all 28 district hospitals in the country plus six facilities affiliated with the Christian Health Association of Malawi. PQI involves establishing and measuring standards.

Design/Methods: Jhpiego conducted a post only quasi-experimental evaluation assessing observed service quality for four RH service areas and three IP service areas. A total of 30 health facilities participated: 17 intervention facilities (9 IP, 8 RH) and 13 comparison facilities (5 IP, 8 RH). A longitudinal data design was employed for the examination of service statistics.

Results : A significantly higher proportion of RH providers at intervention facilities (n=127) met clinical standards than those at comparison facilities (53% vs. 43%, p<.05). Providers from antenatal care (62% vs. 43%, p<.01) and family planning (75% vs. 56%, p<.01) service delivery areas performed significantly better in intervention sites. There were few differences in provider performance for labor and delivery and postnatal care. IP practices in Casualty/Medical/Surgical wards were significantly better in the intervention group than the comparison group (51.5% vs. 35.6%, p<.05), The Operating Theatre showed marginal differences in IP practices.

Implications : The PQI interventions evaluated, which are low cost facility-driven solutions, are effective and are recommended for scale up. Lessons learned from program implementation will be discussed.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research

Learning Objectives:
1. Describe the quality improvement (QI) intervention applied in Malawi to strengthen infection prevention and control (IPC) and reproductive health (RH) services. 2. Analyze the results of an evaluation of the reproductive health quality improvement intervention and identify lessons learned for future programming.

Keywords: Quality Improvement, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a subinvestigator on the study being presented. I have presendted at APHA, GHC and other conferences in the past. I am also a sub-investigator on other similar health facility assessments.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3340.0: Quality of care