AMREF is spearheading research to establish the effectiveness of partner-designed quality (PDQ) – a process that creates interaction between health facility staff and communities – in improving the quality of health and health care in Africa. The system involves getting both sides to discuss what their ideal quality health services are and the obstacles to achieving those ideals, and then finding ways of working together to improve the way things are done and to achieve common quality standards.
A group of organisations using PDQ met in Washington DC this week to evaluate the process, its guidelines and implementation, and to share experiences from projects using the system. The forum, organized by Save the Children, also sought to form a technical advisory committee on PDQ.
Mr William Yaggy, the Director for Institutional Giving, AMREF in USA, spoke about AMREF’s work in the Busia Child Survival Project in Western Kenya, where the system is being used to increase use of maternal child and health services. Besides implementing PDQ, AMREF is collecting data and evidence to establish the effectiveness of the system.
The project has a catchment area of 312 villages in Funyula and Butula divisions, which have 50,000 women of reproductive age and 32,000 children under five years of age. The area has 16 health facilities. AMREF’s rationale for using the PDQ system in Busia arose from the low use of maternal and newborn care services at the health facilities. In 2006, only 32 per cent of women made four ante-natal clinic visits during their last pregnancy. Only 21 per cent of women attending ante-natal services received two doses of medicine to prevent malaria, while only 20 per cent had been attended to by a facility-based health worker during their last pregnancy.
“We realised that women avoided going to the health facilities because they felt the services provided there were poor and ineffective. They also found the health workers unkind, disrespectful and unsupportive. Many women only made single visits to the ante-natal clinic to obtain a card just in case of later complications.”
The aim of the PDQ process was to improve the quality of care provided by health workers at the hospitals, health centres and dispensaries, particularly client-provider interaction, and thus increase use of maternal and newborn services. The exercise targeted pregnant women and mothers with children under five, their husbands, the District Health Management Team, health facility workers, health extension workers and community health workers.
The first phase of the project involved building support for the process in the health services based on the recognition that poor quality of services was a major impediment to use of services. In the second phase, community groups and health workers held separate sessions to define what they each considered to be quality health services. The third phase brought the two groups together at a two-day workshop to create a shared vision of quality, identify problems and priorities, and to create Quality Improvement Teams (QIT) to address the priority problems.
“The project is now in the fourth phase, which involves training the QIT in analysis of problems, identification of possible solutions, and development of action plans. We have seen an uptake in numbers of women. In another six months we will have collected enough data to determine exactly how effective the process has been. Already, there has been a lot of positive response, enthusiasm and excitement among stakeholders. Health workers are making a great effort to provide personalized services, and this is encouraging more women to come to the health facilities,” said William Yaggy.
