142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

311578
Collaborative quality improvement as an approach to strengthen the link between CHWs and the Health Centers in DRC

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Ciro Franco, MD, MPH , Center for Health Services, Management Sciences for Health, Arlington, VA
Narcisse Embeke, MD, Senior Child Health Adviser , Integrated Health Project, DRC, Management Sciences for Health, Kinshasa, Congo-Kinshasa
Jean Fidele Ilunga , Ministry of Health, Kinshasa, Congo-Kinshasa
Gilbert Andrianandrasana , Integrated Health Project , DRC, Management Sciences for Health, Kinshasa, Congo-Kinshasa
Ousmane Faye , Integrated Health Project, DRC, Management Sciences for Health, Kinshasa, Congo-Kinshasa
The Ministry of Health (MOH) in the Democratic Republic of the Congo implemented an integrated community case management (i-CCM) strategy to employ Community Health Workers (CHW) to provide first-line care for malaria, diarrhea and pneumonia among children under five in hard-to-reach areas. Assessments of the strategy revealed quality of care issues, low use of CHWs, infrequent supervisory visits and frequent stock outs.  In response, the USAID-funded Integrated Health Project (IHP) implemented a collaborative approach to improve the quality and increase use of i-CCM in 49 community sites in five health zones. The collaborative approach strengthens links between CHWs and health referral systems, with a focus on the relationship between the health facility and the community. The MOH, in collaboration with IHP, established 49 quality improvement teams comprised of CHWs, health center nurses, and community leaders.  Following this approach, these teams designed and tested strategies, measured common indicators, and met quarterly to share their experiences and results.

After 18 months of collaborative improvement, CHW curative visits have increased from an average of 0.33 cases/day to 1.0/day. The proportion of children CHWs were to refer that were then seen at health facilities increased from 40% to 53%.  Supervision increased from 0.7 visits per month to 1.8.   The percent of community care sites experiencing stock outs of oral rehydration salts decreased from 45 to 13, and malaria medication from 91 to 23.

Given these improvements, the promising practices (effective strategies) tested during the collaborative will be scaled up in all IHP-supported health zones.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Program planning
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
describe key findings of the community case management evaluation in DRC describe promising ICCM practices that will be scaled up

Keyword(s): Quality Improvement, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Child Health Senior Technical Advisor for the DRC-Integrated Health Project, and a medical doctor with over ten years of experiences in primary health care. He works on child survival closely with the Ministry of Health in DRC. I have contributed to the scale up Integrated Community Case Management (i-CCM) and community-based Integrated Management of Childhood Illness in DRC. ________________________________
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.