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Quality improvement to health service delivery

Copyright Malaria Consortium/Tadej ZnidarcicMalaria Consortium views the quality of care provided by any given health system as a key aspect of its overall effectiveness to deliver positive health outcomes for the population it serves. This broadly reflects the WHO framework for Quality of care: a process for making strategic choices in health systems (2006), which states that health systems should seek to make improvements in six key areas: effectiveness, efficiency, accessibility, acceptability, equity and safety. When we implement quality improvement interventions, we aim to improve the quality and performance of health systems in one or more of these six specific target areas.

In order to ensure that health services meet established standards and guidelines, our quality improvement activities focus on improving health worker performance and overcoming barriers to adherence to guidelines.

One of the main goals of our health system strengthening approach is to improve quality of care at the patient level. We do this by mapping the challenges within the continuum of care, as well as the flow and usage of data related to that care, the data available on health outcomes and the use of resources. With these considerations in mind, we design context-appropriate solutions drawing from best practice to overcome identified challenges.

Some of our quality improvement activities include competency-based training and supervision designed to improve adherence to clinical guidelines. This includes certification programmes for malaria microscopy, clinical mentoring, improving clinical standards and evidence-based guidelines, conducting clinical audits, encouraging patient and community engagement, and implementing performance-based incentives.

We focus on ensuring that the delivery of malaria drugs, supplies and commodities is efficient and adequate.

Copyright Malaria Consortium/Peter CatonWe also carry out clinical audits to improve the quality of healthcare services, case management and patient outcomes. This involves systematically reviewing care and services that are currently provided in a health facility against a set of established standards in order to determine which areas are working well and which need improvement. Based on the results, we recommend or carry out further action – such as improvement of severe malaria and dengue case management, improved differential diagnosis, and the resolution of logistical challenges for patients.

Examples of our work

Training healthcare providers and community-based health workers through the Nigeria Malaria Action Programme through States (MAPS) involved a series of training activities designed to enable health systems meet national standards of quality care for malaria case management and improve job performance of health workers at all levels of service delivery. 

Our health systems strengthening efforts across Africa and Asia involve quality improvement processes. For example, our inSCALE project in Uganda and Mozambique focused on improving motivation and retention of volunteer health workers, and one of our COMDIS-HSD projects is studying malaria prevention practices for pregnant women in Uganda in order to address barriers to adherence to antenatal guidelines.


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