Table 1

Preferred examples of quality improvement in Sub-Saharan Africa

Articles from USAID quality improvement projects
(1) Lin Y. Quality in action in Rwanda: case studies. Bethesda (MD): published for the US Agency for International Development (USAID) by the Quality Assurance Project (QAP), 2003.Eighteen staff members from two hospitals and four health centres assessed family planning services at each other's facilities. Interesting insights describe team-based problem solving, service reorganisation to reduce waiting times, and attitude change. ‘Activities/tools: Five data-collection instruments are described, a client-flow data compilation form is pictured, and two examples of assessments are shown’ (from the website).
(2) Assessing the quality of facility-level family planning services in Malawi:
(3) Reports from the USAID quality improvement projects in Nigeria: page lists the quality assurance projects that come from Niger.
(4) Improving the management of obstetric emergencies through case management maps: article described the development of CMMs, informational handouts that were meant to guide healthcare providers in the treatment of patients. Each patient was provided with their own condition-related CMM, which was maintained in the patient's chart or on the wall near the patient's hospital bed to inform providers of the treatment protocol, what treatment was provided when and by whom, and what to do in the case of a critical event occur. This report described a study that implemented two CMMs, introduced about a year apart in a 500-bed hospital where such job aids had not previously been used. The process of planning and implementing the CMMs, the results from this particular implementation, and recommendations for further use of CMMS in developing countries was discussed. Appendices included two CMMs; one for pregnancy-induced hypertensive disorders, and the other is for postpartum haemorrhage.
Other articles
Dohlie MB, Mielke E, Mumba FK, et al. Using practical quality improvement approaches and tools in reproductive health services in east Africa. Jt Comm J Qual Improv 1999;25:574–87.This article is a comprehensive review of a multisite QI initiative by non-profit, NGO Association for Voluntary Surgical Contraception International and its local partners. Their results suggested how a centrally organised QI effort builds capacity that creates ideal conditions for QI, and how generic tools can be adapted to suit local needs and conditions.
Mock CN, Tiska M, Adu-Ampofo M, et al. Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 2002;53:90–7.Mock et al represents a strategy that improved an existing informal emergency transport service network in Accra, Ghana. The strategy used to identify gaps in knowledge and to demonstrate improvements highlights some of the challenges in evaluation that similar studies might confront.
Bradley J, Sikazwe N, Healy J. Improving abortion care in Zambia. Stud Fam Plann 1991;22:391–4.The introduction of manual vacuum aspiration proved to be a simple and effective solution for improving care of the victims of illegal abortions. Clear outcomes related to patient care (such as wait times), and clinical operations are listed.
Hane F, Thiam S, Fall AS, et al. Identifying barriers to effective tuberculosis control in Senegal: an anthropological approach. Int J Tuberc Lung Dis 2007;11:539–43.These two articles represent two stages of a QI project to address tuberculosis control in Senegal. The first article describes qualitative efforts to identify specific barriers to tuberculosis treatment. The second article describes a randomised control study that used quantitative measures to evaluate the success of the designed intervention.
Thiam S, LeFevre AM, Hane F, et al. Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial. JAMA 2007;297:380–6.
Aziz M, Bretzel G. Use of a standardized checklist to assess peripheral sputum smear microscopy laboratories for tuberculosis in Uganda. Int J Tuberc Lung Dis 2002;6:340e9.A checklist of structure and process good practices was used to make improvements in 304 TB clinics.
Kelly, Paul M. Local problems, local solutions: improving tuberculosis control at the district level in Malawi. Bull World Health Organ 2001;79:11117. TB cure rates for treatment survivors rose from 29% in 1990–1991 to 92% in 1992–1993.This study evaluated the implementation of a tuberculosis control intervention in an NGO hospital in Malawi. The success of the intervention is evaluated by a set of outcomes explicitly explained in the article.
  • CMMs, case management maps; NGO, non-governmental organisation; QI, quality improvement; USAID, US Agency for International Development.