Alignment, engagement and collaboration: approaches to ensuring Quality Improvement is embedded
By Rosalind Steege
Panellists: Allone Ganizani, Chief Environmental Health Officer, Ministry of Health, Malawi; Buriso Shasamo, Head of Shebedino district, Sidama (REACHOUT implementing district), Ethiopia; Charity Tauta, Head of Operations Research in the community health and development unit, Ministry of Health, Kenya; Ershad Hoque (Bangladesh); Bedilu Badego Director of the Zonal Health Bureau, Ethiopia; Stelio Dimande Ministry of Health, Mozambique
Engagement with policy makers is key to research uptake. That’s why at the 5th REACHOUT consortium meeting in Cianjur, Indonesia, our six country teams were joined by policy makers, practitioners and NGO lead implementers from each country context.
On the last day of the meeting, not wanting to miss an opportunity to hear from key decision makers, we held a panel to explore perspectives on embedment of quality improvement cycles. The panel included Ministry of Health staff from national, zonal and district levels and was chaired by Professor Sally Theobald of Liverpool School of Tropical Medicine. We wanted to find out what really makes policy players sit up and take note of research, and find out their advice to strategies and approaches to embed quality improvement (QI) - the focus for the second REACHOUT QI cycle.
What messages research methods and communication types influence you the most – what do you like to hear from researchers and partners? What’s the most influential and positive for you?
Our panellists highlighted that the voice of the community is the most influential. From Kenya, Charity Tauta noted: “Not through research as such, but through our interactions when we are with them [the community]. You listen, and you hear that they are saying things that point to us as health workers not really delivering. That would make me think we need to do things differently.” Similarly, in Bangladesh, Ershad explained that visits to the Pushtans are a way to hear the voice of the community, while in Ethiopia a more structured approach is taken, with quarterly meetings with the community and the staff who serve the community, to hear their ideas and experiences.
Close-to-community (CTC) providers were cited as an important part of linking communities with the health system as they often bring forward issues from the community. “At health post level the Health Extension Workers also raise interesting ideas since they are engaged with the community. So I want research that is done at the community level.” (Bedilu Badego)
You see a lot of projects come and go; what makes some stick and others not? What are your experiences of sustaining programmes into government health systems?
Experience from Malawi, Mozambique and Ethiopia suggests that failures in resource mobilisation and fragmentation of donors is a key reason for projects failing to be sustained. Stelio Dimande from the Ministry of Health, Mozambique, advised that coordinated approaches and a unified strategic objective for CTC providers in Mozambique is key:
“I can see that when we talk about CTC providers we are not always speaking the same language… Every NGO and partner has their own agenda at the end of the period and I think that something that’s missed is to develop a national strategy to CTC providers” (Stelio Dimande)
Allone Ganizani, Malawi, and Buriso Shasamo, Ethiopia, also stated that in addition to resource constraints, without effective exit strategies the sustainability of projects can be affected; implementers need to look at the resources of the community to ensure that they not only have the resources to be able to continue with the projects, but the capacity to use those resources to continue.
What does it take for something to make it into a budgeting cycle? Taking into account that financial incentives and allowances often drive participation in projects how best can REACHOUT embed without compromising the QI cycle?
Alignment with national priorities was seen to be key in ensuring that innovations make it into the budgeting cycle. Our colleague from Kenya also spoke to the need for clear, thought through concepts from partners and the importance of developing concept notes in partnership.
Budgeting is a complicated process and the panel emphasised the need for a transparent and collaborative approach and pointed to thematic working groups and advisory groups of being a key way to achieve this.
“If we have a specific plan for each project we will go back to fragmentation at the end of the day. To have sustainability in all actions we have to integrate the plans and have a clear vision of the total project resources… transparency here is important.” (Stelio Dimande)
How would you embed QI? What challenges do you anticipate and what pitfalls can we avoid?
Panellists from Malawi and Ethiopia, where QI is already part of the approach, fielded this question and spoke of the importance of ownership across different levels, from community through to government level. Highlighting the need for community members, who are using the services, to have access to the guidelines and become familiar with QI issues so that they can judge the quality of services and recognise the value themselves. From Malawi, Allone Ganizani discussed ownership at the government level: “It doesn’t have to be a REACHOUT activity. We have to feel that ownership. We do that by participating and taking lead in the whole process. Let us come up with the quality indicators ourselves that we want to monitor.” Buriso Shasamo also commented that professional commitment and energy is needed to ensure that the QI already in place becomes embedded: “In our districts we have started but the challenge is a lot of energy is needed to mobilise… Mobilise and work together.”
At the end of the lively and engaging discussion the key messages for researchers that consistently came through were:
- The need for inclusive plans and budgets that all donors collaborate on, in order to avoid fragmentation
- Alignment of research and interventions with national priorities to ensure uptake and embedment, “That’s why we are excited about REACHOUT, maternal health is a priority for the country” (Bedilu Badego)
- Engagement with government to bring evidence to the fore, collaborate on policy briefs and bring different perspectives to the table is also vital as researchers. “Dialogue with us…work with us. We don’t always see it the way you see it. We don’t interpret it as you do. So we need you to be close to us. What you [REACHOUT] are bringing on board is important”(Charity Tauta)
- Finally, researchers should also be aware of timeliness of engagement with government for embedding QI. Engaging policymakers during the development of country’s five-year strategic plans is crucial in influencing budgets and agendas
We look forward to continuing to learn from and work in partnership with policy players as we continue our REACHOUT journey.
Recent news
- Participation, perspectives and possibilities: Mobiles, Development and Global Health, 29 October 2015
- REACHOUT holds Consortium meeting in Indonesia, 26 October 2015
- We must move beyond the ‘pay vs. no pay’ debate for community health workers, 6 October 2015
This project is funded by the European Union.