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Article on Improving Healthcare Worker Performance to be Published by International Journal

An article by the QA Project on improving healthcare worker compliance with the World Health Organization’s Integrated Management of Childhood Illness standards in Niger, West Africa, was recently accepted for publication in the prestigious International Journal for Health Planning and Management.

The paper, "Improving Performance with Clinical Standards: The Impact of Feedback on Compliance with the Integrated Management of Childhood Illness Algorithm in Niger, West Africa," will be published in Volume 16 Number 3.

Niger is one of the world’s poorest countries and, at the time of the research, had the world’s highest child mortality. Inadequate healthcare coverage, weak health system management, insufficient healthcare worker training, and scarce resources limit efforts to deliver effective services. Here, low-cost techniques for supporting health workers are sorely needed.

The USAID-funded joint BASICS/Quality Assurance Project tested several research-based interventions in three districts in Niger, West Africa to improve case management of sick children. The paper presented the results of a comparison of healthcare worker feedback to communicate IMCI standards and improve compliance with these standards, which included assessment, treatment and counseling of sick children, compared with formal IMCI training in terms of impact and cost.

Results showed that performance feedback had a significant effect on compliance, which improved between 34 and 85 percent in areas of assessment of sick children. Performance feedback also was less expensive than formal training (costing $108 per health worker versus $430 per worker for formal IMCI training).

The QA Project worked in Niger from 1992 to 1996 to improve primary healthcare and child survival, and continued its work with the BASICS (Basic Support for Institutionalizing Child Survival) Project from 1996 to 1998. The research took place from June 1997 to December 1998.

Performance feedback had the greatest effect in areas where healthcare workers performed poorly, while areas in which compliance was high eventually saw declines. The results indicate that performance feedback shows promise as a method to improve quality of care with clinical approaches such as IMCI, and particularly if tied to other performance improvement interventions.

The article was written by Edward Kelley, PhD, Senior Quality Assurance Advisor, QA Project, Colette Geslin, MD, Technical Advisor, Basic Support for Institutionalizing Child Survival (BASICS) Project, Sabou Djibrina, TSSI, Senior Quality Assurance Advisor, QA Project, and Maina Boucar, MD, MPH, QA Project.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.