HP&P – Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation
“Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential. Nigeria introduced DIVA (Diagnose-Intervene-Verify-Adjust) as a model to strengthen decentralized PHC planning. However, implementation has been poorly sustained. This article explores the role of actors and context in implementation and sustainability of DIVA in two local government areas (LGAs) in Nigeria. … … Then using the Model for Understanding Success in Quality (MUSIQ), we measured contextual factors affecting implementation of DIVA in the selected LGAs. The LGAs scored 117.42 and 104.67 out of 168 points on the MUSIQ scale, respectively, indicating contextual barriers exist. Both have strong DIVA team attributes, but these could not independently ensure quality implementation. Although external support accounted for the greatest contextual disparities, the utmost implementation challenges relate to subnational government leadership, management, financial and technical support. Although higher levels of government may set visionary goals for PHC, interventions are potentially skewed towards donor interests at lower (implementation) levels. Thus, subnational political will is a key determinant of quality implementation. Consequently, advocacy for responsible and accountable political governance is essential in comparable decentralized contexts.”
Social Science & Medicine – Quality of clinical care and bypassing of primary health centers in India
“…This study examines the role of quality of care, in particular clinician competence and structural quality of the health center, on bypassing behavior. Data for this study comes from a survey of 136 primary health centers (PHCs) and 3517 individuals living in the PHC’s immediate vicinity in rural Chhattisgarh, India….”
Some highlights: “Bypassing primary health centers falls as clinician competency increases. Beyond a threshold, there is no effect of improved competency on bypassing. Clinician competence reduces bypassing more than better structural quality. Patients that bypassed had higher out-of-pocket health expenditures. Bypassing highlights a need to make PHCs more relevant to communities. “
BMJ Open – Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal.
D Besada et al; http://bmjopen.bmj.com/content/bmjopen/8/3/e020754.full.pdf
This study explores the roles of community cadres in improving access to and retention in care for PMTCT (prevent mother-to-child transmission of HIV) services in the context of PMTCT Option B+ treatment scale-up in high burden low-income and lower-middle income countries. Study in Malawi, Cote d’Ivoire, DRC and Uganda.
The conclusion: “Community cadres provide an integral link between communities and health facilities, supporting overstretched health workers in HIV client support and follow-up. However, their role in health systems is neither standardised nor systematic and there is an urgent need to invest in the standardisation of and support to community cadres to maximise potential health impacts. ”