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Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

Iyer HS, Kamanzi E, Mugunga JC, Finnegan K, Uwingabiye A, Shyaka E, Niyonzima S, Hirschhorn LR, Drobac PC - Glob Health Action (2015)

Bottom Line: Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002).Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline.This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

View Article: PubMed Central - PubMed

Affiliation: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.

ABSTRACT

Background: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda.

Design: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach.

Results: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline.

Conclusions: Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

No MeSH data available.


Related in: MedlinePlus

Per capita HS investments* in 2011 USD by funding source among intervention facilities (N=14) over a 12-month period to reference facilities (N=6) at baseline. *Includes in-kind donations.
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Figure 0001: Per capita HS investments* in 2011 USD by funding source among intervention facilities (N=14) over a 12-month period to reference facilities (N=6) at baseline. *Includes in-kind donations.

Mentions: During the 12-month intervention period, the partnership's investment in health center readiness was $4.03 per capita, though allocation varied across the 14 health center catchments (median: $4.01, range: $1.00–$15.96 per capita). This comprised 26% of total per capita health funding ($15.58) in the intervention catchment area. Per capita government funding remained relatively constant from the pre-intervention year ($8.68, or 54% of total) to the intervention year ($8.08, 52%), while external funding declined from $5.32 (33%) per capita to $2.05 (13%). The latter reflected a one-time, in-kind contribution of medical equipment and furniture by a multilateral partner during the pre-intervention year that was received by most health centers in the country. As such, despite the new investment from the HSS intervention, total per capita funding in the catchment area declined 3% from the pre-intervention year to the intervention year ($16.12–$15.58). Total per capita funding in the intervention catchment was 17% less than that of the reference facility area, though distribution of funding sources was similar (Fig. 1).


Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

Iyer HS, Kamanzi E, Mugunga JC, Finnegan K, Uwingabiye A, Shyaka E, Niyonzima S, Hirschhorn LR, Drobac PC - Glob Health Action (2015)

Per capita HS investments* in 2011 USD by funding source among intervention facilities (N=14) over a 12-month period to reference facilities (N=6) at baseline. *Includes in-kind donations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490804&req=5

Figure 0001: Per capita HS investments* in 2011 USD by funding source among intervention facilities (N=14) over a 12-month period to reference facilities (N=6) at baseline. *Includes in-kind donations.
Mentions: During the 12-month intervention period, the partnership's investment in health center readiness was $4.03 per capita, though allocation varied across the 14 health center catchments (median: $4.01, range: $1.00–$15.96 per capita). This comprised 26% of total per capita health funding ($15.58) in the intervention catchment area. Per capita government funding remained relatively constant from the pre-intervention year ($8.68, or 54% of total) to the intervention year ($8.08, 52%), while external funding declined from $5.32 (33%) per capita to $2.05 (13%). The latter reflected a one-time, in-kind contribution of medical equipment and furniture by a multilateral partner during the pre-intervention year that was received by most health centers in the country. As such, despite the new investment from the HSS intervention, total per capita funding in the catchment area declined 3% from the pre-intervention year to the intervention year ($16.12–$15.58). Total per capita funding in the intervention catchment was 17% less than that of the reference facility area, though distribution of funding sources was similar (Fig. 1).

Bottom Line: Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002).Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline.This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

View Article: PubMed Central - PubMed

Affiliation: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.

ABSTRACT

Background: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda.

Design: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach.

Results: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline.

Conclusions: Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

No MeSH data available.


Related in: MedlinePlus