Institutionalizing critical elements of quality improvement processes in resource-poor settings: Experiences from Nigeria

Northern Nigeria has one of the highest maternal mortality ratios in the world (up to 2,000 per 100,000 live births) (Adamu et al 2003). A major impediment to improving maternal health and attaining the Millennium Development Goals (MDGs) is providing quality RMNCH services at all levels of the health care system. The United Kingdom’s Department for International Development (DFID)-funded Partnership for Transforming Health Systems 2 (PATHS2) project is supporting the Government of Nigeria to use its own resources efficiently and effectively to achieve the MDGs. 

PATHS2 has been operationalizing a concentric model and service delivery strategy to demonstrate effective and efficient delivery of quality services for improved health outcomes for women and children in its focal states.  A package of interventions that included critical elements of quality of care to ensure availability of health commodities, basic infrastructure, human resources, referrals, supportive supervision, health management information systems, community mobilization, and accountability was implemented leading to significant improvements in service delivery

Results indicate a 59% increase in the number of primary health care facilities with essential drugs consistently available (>90% of the time); and a 97.7% increase in supported health facilities providing standard emergency obstetric care services. In supported communities, there was increased recognition of maternal danger signs and an improved referral system which led to the transportation of over 2,600 women in need of emergency obstetric care to health facilities. This process demonstrated that Quality Improvement Processes can be institutionalized within the public sector health care delivery system in resource-poor settings.