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1.
Soc Sci Med ; 85: 87-92, 2013 May.
Article in English | MEDLINE | ID: mdl-23540371

ABSTRACT

Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through these programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). In this paper, we describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May-June 2011. We discuss considerations for other programs interested in adopting such systems. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.


Subject(s)
Community Health Workers/statistics & numerical data , Data Collection/standards , Program Evaluation/methods , Quality Assurance, Health Care/organization & administration , Humans , Rwanda
2.
Trop Med Int Health ; 18(1): 18-26, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23279379

ABSTRACT

OBJECTIVES: To show the utility of combining routinely collected data with geographic location using a Geographic Information System (GIS) in order to facilitate a data-driven approach to identifying potential gaps in access to emergency obstetric care within a rural Rwandan health district. METHODS: Total expected births in 2009 at sub-district levels were estimated using community health worker collected population data. Clinical data were extracted from birth registries at eight health centres (HCs) and the district hospital (DH). C-section rates as a proportion of total expected births were mapped by cell. Peri-partum foetal mortality rates per facility-based births, as well as the rate of uterine rupture as an indication for C-section, were compared between areas of low and high C-section rates. RESULTS: The lowest C-section rates were found in the more remote part of the hospital catchment area. The sector with significantly lower C-section rates had significantly higher facility-based peri-partum foetal mortality and incidence of uterine rupture than the sector with the highest C-section rates (P < 0.034). CONCLUSIONS: This simple approach for geographic monitoring and evaluation leveraging existing health service and GIS data facilitated evidence-based decision making and represents a feasible approach to further strengthen local data-driven decisions for resource allocation and quality improvement.


Subject(s)
Cesarean Section/statistics & numerical data , Emergency Medical Services/standards , Geographic Information Systems/statistics & numerical data , Health Services Accessibility , Health Services Research/methods , Maternal Health Services/standards , Pregnancy Complications/epidemiology , Adult , Emergency Medical Services/statistics & numerical data , Female , Fetal Mortality , Health Services Needs and Demand , Hospitals , Humans , Incidence , Maternal Health Services/statistics & numerical data , Pregnancy , Quality Improvement , Research Design , Resource Allocation , Rural Health Services/standards , Rural Health Services/statistics & numerical data , Rural Population , Rwanda/epidemiology , Uterine Rupture/epidemiology
3.
Nurs Outlook ; 61(3): 137-44, 2013.
Article in English | MEDLINE | ID: mdl-23164530

ABSTRACT

Quality of care at rural health centers in Rwanda is often limited by gaps in individual nurses' knowledge and skills, as well as systems-level issues, such as supply and human resource management. Typically, nurse training is largely didactic and supervision infrequent. Partners In Health and the Rwandan Ministry of Health (MOH) collaborated to implement the nurse-focused Mentoring and Enhanced Supervision at Health Centers (MESH) program. Rwandan nurse-mentors trained in quality improvement and mentoring techniques were integrated into the MOH's district supervisory team to provide ongoing, on-site individual mentorship to health center nurses and to drive systems-level quality improvement activities. The program targeted 21 health centers in two rural districts and supported implementation of MOH evidence-based protocols. Initial results demonstrate significant improvement in a number of quality-of-care indicators. Emphasis on individual provider and systems-level issues, integration within MOH systems, and continuous monitoring efforts were instrumental to these early successes.


Subject(s)
Delivery of Health Care/organization & administration , Education, Nursing/organization & administration , Mentors , Quality Improvement/organization & administration , Rural Health Services/organization & administration , Humans , Program Evaluation , Rwanda
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