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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

Standardized comparisons of intervention facilities (N=14) at baseline and 12 months to baseline facility scores for reference facilities.
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Figure 0004: Standardized comparisons of intervention facilities (N=14) at baseline and 12 months to baseline facility scores for reference facilities.

Mentions: We found that implementation of a tool to rapidly assess service availability and facility readiness, combined with engagement of local leaders to utilize these data to identify priority areas for resource allocation, was effective in improving facility readiness in rural Rwanda. Composite scores for intervention facilities had caught up to the baseline scores of the reference facilities, reflective of gains in the infrastructure, medical equipment, social services, and M&E domains (Fig. 4). Our results suggest that we were successful in engaging local leaders to improve equity in health service delivery readiness across the district focusing on health centers targeted for this year-long intervention. Indeed, improvements were greatest among facilities with the lowest readiness scores at baseline (Fig. 3).


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)

Standardized comparisons of intervention facilities (N=14) at baseline and 12 months to baseline facility scores for reference facilities.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: Standardized comparisons of intervention facilities (N=14) at baseline and 12 months to baseline facility scores for reference facilities.
Mentions: We found that implementation of a tool to rapidly assess service availability and facility readiness, combined with engagement of local leaders to utilize these data to identify priority areas for resource allocation, was effective in improving facility readiness in rural Rwanda. Composite scores for intervention facilities had caught up to the baseline scores of the reference facilities, reflective of gains in the infrastructure, medical equipment, social services, and M&E domains (Fig. 4). Our results suggest that we were successful in engaging local leaders to improve equity in health service delivery readiness across the district focusing on health centers targeted for this year-long intervention. Indeed, improvements were greatest among facilities with the lowest readiness scores at baseline (Fig. 3).

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