A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved]
Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Villa...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2019-08-01
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| Series: | Gates Open Research |
| Online Access: | https://gatesopenresearch.org/articles/3-1481/v2 |
| _version_ | 1818991886367457280 |
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| author | Christine Kim Ramadhan Kirunda Frederick Mubiru Nilufar Rakhmanova Leigh Wynne |
| author_facet | Christine Kim Ramadhan Kirunda Frederick Mubiru Nilufar Rakhmanova Leigh Wynne |
| author_sort | Christine Kim |
| collection | DOAJ |
| description | Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention. Methods: We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions. Results: The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled. Conclusions: A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations. |
| first_indexed | 2024-12-20T20:17:23Z |
| format | Article |
| id | doaj.art-d694be2bd3e047909e94ef2a2770f730 |
| institution | Directory Open Access Journal |
| issn | 2572-4754 |
| language | English |
| last_indexed | 2024-12-20T20:17:23Z |
| publishDate | 2019-08-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | Gates Open Research |
| spelling | doaj.art-d694be2bd3e047909e94ef2a2770f7302022-12-21T19:27:40ZengF1000 Research LtdGates Open Research2572-47542019-08-01310.12688/gatesopenres.12973.214184A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved]Christine Kim0Ramadhan Kirunda1Frederick Mubiru2Nilufar Rakhmanova3Leigh Wynne4Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7411, USAFHI 360, Kitante Close, Kampala, UgandaFHI 360, Kitante Close, Kampala, UgandaFHI 360, 825 Connecticut Ave NW, Washington, DC, 20009, USAFHI 360, 359 Blackwell Street #200, Durham, NC, 27701, USABackground: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention. Methods: We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions. Results: The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled. Conclusions: A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.https://gatesopenresearch.org/articles/3-1481/v2 |
| spellingShingle | Christine Kim Ramadhan Kirunda Frederick Mubiru Nilufar Rakhmanova Leigh Wynne A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] Gates Open Research |
| title | A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] |
| title_full | A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] |
| title_fullStr | A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] |
| title_full_unstemmed | A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] |
| title_short | A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda [version 2; peer review: 2 approved] |
| title_sort | process evaluation of the quality improvement collaborative for a community based family planning learning site in uganda version 2 peer review 2 approved |
| url | https://gatesopenresearch.org/articles/3-1481/v2 |
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