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Open Access Study protocol

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

Claudia Hanson125*, Peter Waiswa13, Tanya Marchant2, Michael Marx4, Fatuma Manzi5, Godfrey Mbaruku5, Alex Rowe6, Göran Tomson17, Joanna Schellenberg2, Stefan Peterson138 and and the EQUIP Study Team

Author Affiliations

1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

2 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom

3 Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda

4 Evaplan GmbH the University of Heidelberg, Heidelberg, Germany

5 Ifakara Health Institute, Dar-es-Salaam, Tanzania

6 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA

7 Department of Learning, Informatics, Management, Ethics; Karolinska Institutet, Stockholm, Sweden

8 Department of Women’s and Children’s Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden

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Implementation Science 2014, 9:41  doi:10.1186/1748-5908-9-41

Published: 2 April 2014

Abstract

Background

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

Methods

In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.

Discussion

EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.

Trial registration

PACTR201311000681314

Keywords:
Quality management; Quality improvement; Maternal and child health; Health system strengthening; Community empowerment; Tanzania; Uganda