Building District‐Level Capacity for Continuous Improvement in Maternal and Newborn Health. (January 2014)

• Record Type: Journal Article
• Authors: Stover, Kim Ethier; Tesfaye, Solomon; Frew, Aynalem Hailemichael; Mohammed, Hajira; Barry, Danika; Alamineh, Lamesgin; Teshome, Abebe; Hepburn, Kenneth; Sibley, Lynn M.
• Is Part Of: Journal of midwifery & women's health. Volume 59:Number 1(2014:Jan./Feb.)
• Page Start: S91
• Page End: S100
• Publication Date: 2014-01
• Subjects: Midwives -- Periodicals; Obstetrics -- Periodicals; Women's health services -- Periodicals; 618.2
• DOI: 10.1111/jmwh.12164
• Languages: English
• ISSNs: 1526-9523

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jmwh12164-sec-0010" sec-type="section"> <title>Introduction</title> <p>The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop <italic>woreda</italic> (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other <italic>woredas</italic>, dubbed "lead" <italic>woredas</italic>. Community‐level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care.</p> </sec> <sec id="jmwh12164-sec-0020" sec-type="section"> <title>Methods</title> <p>Surveys and in‐depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated <italic>woreda</italic> culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes.</p> </sec> <sec id="jmwh12164-sec-0030" sec-type="section"> <title>Results</title> <p>Respondents reported significant positive changes in many areas of <italic>woreda</italic> culture and leadership, including involving a cross‐section of community stakeholders (increased from 3.0 to 4.6 on 5‐point Likert scale), using improvement data for decision making (2.8‐4.4), using locally developed and tested solutions to improve CMNH care (2.5‐4.3), demonstrating a commitment to improve the health of women and newborns (2.6‐4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6‐4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the <italic>woredas</italic>. The themes of community empowerment and focused improvement emerged strongly from the interviews.</p> </sec> <sec id="jmwh12164-sec-0040" sec-type="section"> <title>Discussion</title> <p>MaNHEP was able to build capacity for continuous improvement and develop lead <italic>woredas</italic>. The multifaceted approach to building capacity was critical for the success in creating lead <italic>woredas</italic> able to serve as models for other districts.</p> </sec> </abstract>