Brazil Case Study | Ghana IP Case Study

Collaborating Partners: JHPIEGO, Johns Hopkins University/Center for Communication Programs, Population Services International, Tulane University

In West Africa, the Santé Familiale et Prévention du SIDA (SFPS) project integrates both performance and quality improvement elements in its multi-agency collaborative approach. SFPS is a regional performance-based reproductive health project funded by USAID and implemented by four Cooperating Agencies. Target countries include: Burkina Faso, Côte d’Ivoire, Cameroon and Togo. SFPS intervenes and measures performance on both the provider and client side of the family planning (FP) service equation. The quality of provider performance (how competently and efficiently people are doing their work) contributes to reaching more clients. Improvements in quality of care attract, maintain and accommodate more FP clients in the program. The SFPS project has inherently followed the 5-step performance improvement process.

1. Performance Analysis

SFPS has designed a quality of care diagnostic tool that measures the quality of family planning services at healthcare delivery sites by examining 66 criteria. Data are collected through interviews with clients and providers, observation of clinical practice, and review of site management and logistics procedures. Gaps between actual and desired quality performance are identified and analyzed.

2. Root Cause Analysis

Causes of performance and quality gaps are broadly grouped to include:

• Clinical knowledge and skill deficits among healthcare providers

• Low demand for family planning services, stemming from knowledge and awareness gap

• Weak management/logistics capacity (little control over procurement, planning and budgets)

• Low motivation caused by inadequate and irregular pay

• Weak communication and counseling skills of healthcare providers

3. Intervention Selection

Based on the cause analysis, action plans are designed and interventions from five major categories are strategically applied:

• Service Delivery: Establishment of health information and logistics systems and the provision of medical material and equipment.
• Training: Development of national training systems and training programs in health schools and in the workplace in order to improve the capacities of institutions and the skills of health professionals.
• Social Marketing: Assurance that key products such as condoms, hormonal contraceptives and oral rehydration salts are well known and distributed at a reasonable price, through channels that are accessible by the majority of the target population.
• Information, Education and Communication (IEC): Development and printing of IEC materials for service providers and clients, development of training programs to address communication and counseling weaknesses in service delivery and outreach, and the development of mass media campaigns that promote and model positive health behaviors.
• Rewards and Recognition: Establishment of an accreditation model through which sites that meet the quality criteria are declared Gold Circle sites. The surrounding community is then mobilized to further promote the use of services provided in the Gold Circle sites. The quality work of service providers is publicly recognized. Public recognition motivates providers to keep providing high standard work.

4. Implementation

The operations research component of the project is responsible for monitoring the impact of the interventions and continuously providing feedback for qualitative and quantitative program improvement. This component aims at improving efficiency and effectiveness by diagnosing service delivery problems, testing performance improvement strategies and proposing solutions. As a result, the project’s approach is being continuously refined. Criteria of quality of care have been reviewed and revised. The Gold Circle accreditation model will also be reviewed and possibly revised.

5. Monitoring and Evaluation of Performance

In the first four years of the project SFPS succeeded in upgrading quality of care and motivating service providers. This has led to a greater use of family planning services. Couple Years of Protection (CYP) generated by the 206 participating sites has steadily increased each year since 1995 and has exceeded expectations each year.

Go to Performance Improvement