Improving district facility readiness

A 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

Bibliographic Data

ID19530664
AuthorsHari S Iyer (0000-0002-7596-9049, Brigham and Women's Hospital, corresponding author), Emmanuel Kamanzi (Partners In Health), Jean Claude Mugunga (0000-0003-1210-7422, Partners In Health), Karen E Finnegan (0000-0001-9007-5417, Johns Hopkins University), Karen Finnegan, Alice Uwingabiye, Edward Shyaka, Saleh Niyonzima (Ministry of Health), Lisa R Hirschhorn (0000-0002-4355-7437, Brigham and Women's Hospital), Peter Drobac (0000-0001-5190-6767, Brigham and Women's Hospital), Peter C Drobac
Year2015
Volume8
Issue1
Pages28365
Publication date2015-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueGlobal Health Action (JOURNAL)
Journal identifiersISSN: 1654-9716 • E-ISSN: 1654-9880
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.3402/gha.v8.28365
PMID26140729
OpenAlexW1513314318
LanguageEN
Citations received1
References cited14

BACKGROUND: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. DESIGN: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. RESULTS: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. CONCLUSIONS: Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level

Business · Environmental health · General partnership · Health facility · Health services · Political science · Population · Psychological intervention · Public relations · Rural area · Rural health · Stakeholder · Global Health and Surgery · Global Maternal and Child Health · Health Policy Implementation Science · Medicine · Nursing · Finance

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