Data-driven quality improvement: Lessons from MANI Project in Bungoma
Since 2015, the Maternal and Newborn Improvement (MANI) project has provided technical assistance to the Bungoma County government to improve management and performance of the health system under devolution. This included a focus on strengthening health information systems to improve quality of care and accountability. While routine data collection was being done well, the use of that data for decision-making was a management gap. In this edition of Vumbua News, we highlight some best practices from MANI project that could be applied more widely to enhance the use of data to drive improvement in healthcare quality.
- Using data to increase availability of emergency services: the MANI project used a Quality of Institutional Care (QuIC) scorecard to routinely measure and track health facilities’ readiness to provide quality Emergency Obstetric and Newborn Care (EmONC) services. The QUIC scorecard helped identify gaps, develop and implement targeted action points to improve EmONC delivery. Through this process, the number of EmONC facilities increased enormously, from only one hospital in 2015 to 32 health facilities in 2018.
- Using MPDSR to inform remedial actions: Maternal and Perinatal Death Surveillance and Response (MPDSR) was routinely conducted at health facilities, sub county and county levels. Each maternal death, and more than half of all perinatal deaths, were individually reviewed each month to identify learning and actions for preventing similar mortalities. The county identified blood shortages and lack of newborn resuscitation skills as two major gaps. As a remedial action, Bungoma prioritized support for blood donation drives to boost available blood stocks from 400 to 600 pints per month. To address the skills gap, the county initiated a mentorship program to build health worker capacity in priority skills. This approach not only improved quality of care, but also helped reduce the workload and congestion in referral health facilities.
- Tapping the community voice: Citizen participation and engagement in healthcare planning is a key driver of service uptake and accountability. The MANI project used a community accountability scorecard process to tap into the community voice, integrating client feedback into healthcare decision-making. The scorecard provided feedback data that became the basis for negotiations between service providers and users, and acted as a reference point for tracking progress on mutually agreed actions. Routine use of client feedback helped improve the linkages and relationships between communities and their health facilities.
- Building a culture of data-driven decision making: Improving service delivery requires an operating environment that seeks to leverage data to enhance effectiveness and efficiency. In this regard, MANI supported the formation, institutionalization and functionality of technical working groups, data quality improvement teams and quality of care committees at county, sub-county and facility levels respectively. These teams and forums were critical in fostering a sense of shared responsibility for achieving quality improvement and accountability.
Lessons from the MANI project remind us that data is at the heart of continuous quality improvement. However, in the absence of timely analysis and use for decision making, the routine collection of data is a futile exercise. Unless health services managers, providers and users are able to extract meaning from the data, they will not be able to use it to guide appropriate quality-improvement decisions. Adopting proven tools and processes can result in demonstrable positive outcomes.