Online Program

Evidence of sustainability of a quality improvement approach in Malawi

Monday, November 4, 2013 : 3:15 p.m. - 3:30 p.m.

Sara Gullo, MPH, Sexual Reproductive and Maternal Health Team, CARE USA, Atlanta, GA
Christine Galavotti, PhD, Sexual, Reproductive and Maternal Health Team, CARE, Atlanta, GA
Thumbiko Msiska, Maternal Health Alliance Project, CARE Malawi, Atlanta, GA
Lara Altman, MPH/MSW Candidate, Consultant for CARE, Atlanta, GA
From 2002-2010, CARE Malawi implemented Supporting and Mitigating the Impact of HIV/AIDS for Livelihoods (SMIHLE) project. SMHILE's midterm evaluation highlighted implementation issues, which a quality improvement approach, the Community Score Card (CSC), was introduced to address. The CSC methodology involves citizen representatives and service providers in a mutual process of identifying problems, generating solutions, and working in partnership to improve services. Despite the fact that CARE's support for the SMHILE project ended in 2010, community members have continued to implement the CSC on their own. In 2012, over 2 years after the end of SMHILE, four focus group discussions with women, the CSC committee, and the broader community were conducted to examine factors that contributed to the CSC sustainability, how the community has applied the CSC, and the outcomes that have resulted from the CSC process. The sustainability of the CSC was attributed to good CSC training before SMHILE's close-out, a sense of citizenship and responsibility, the adaptability of the process and witnessing positive benefits from the CSC process. In addition, there is evidence of the following: 1) adaptability of the CSC process, 2) community empowerment, accountability and responsiveness of service providers, expanded spaces for dialogue between service providers and users, and 3) improvements in health service delivery. With these results in mind, CARE is currently conducting a cluster-randomized control evaluation of the CSC's effect on maternal and newborn health service implementation and outcomes in Malawi.

Learning Areas:

Public health or related research

Learning Objectives:
Describe the quality improvement approach, which was implemented as part of an HIV/AIDS project in Malawi implemented from 2002-2010, that a community continues to carry out without external support. Explain the qualitative research conducted to examine why the quality improvement approach has been sustainable, how the community implements the tool, and what outcomes have resulted . Identify factors that may contriubte to the sustainability of quality improvement efforts

Keyword(s): Quality Improvement, Sustainability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have be the co-lead of this research investigating the sustainability of a quality improvement approach in Malawi. Among my public health interests and work has been the development of approaches and methods to improve the quality and implemenation of health services. Currenlty I am co-leading a cluster randomized control evaluation of a participatory implementation science approach in Malawi.
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.