Collaborative quality improvement as an approach to strengthen the link between CHWs and the Health Centers in DRC

The Ministry of Health (MOH) in the Democratic Republic of the Congo implemented an integrated community case management (i-CCM) strategy to employ Community Health Workers (CHW) to provide first-line care for malaria, diarrhea and pneumonia among children under five in hard-to-reach areas. Assessments of the strategy revealed quality of care issues, low use of CHWs, infrequent supervisory visits and frequent stock outs.  In response, the USAID-funded Integrated Health Project (IHP) implemented a collaborative approach to improve the quality and increase use of i-CCM in 49 community sites in five health zones. The collaborative approach strengthens links between CHWs and health referral systems, with a focus on the relationship between the health facility and the community. The MOH, in collaboration with IHP, established 49 quality improvement teams comprised of CHWs, health center nurses, and community leaders.  Following this approach, these teams designed and tested strategies, measured common indicators, and met quarterly to share their experiences and results.

After 18 months of collaborative improvement, CHW curative visits have increased from an average of 0.33 cases/day to 1.0/day. The proportion of children CHWs were to refer that were then seen at health facilities increased from 40% to 53%.  Supervision increased from 0.7 visits per month to 1.8.   The percent of community care sites experiencing stock outs of oral rehydration salts decreased from 45 to 13, and malaria medication from 91 to 23.

Given these improvements, the promising practices (effective strategies) tested during the collaborative will be scaled up in all IHP-supported health zones.