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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Protocol-driven primary care and community linkages to improve population health in rural Zambia: The Better Health Outcomes through Mentoring and Assessment (BHOMA) project
BMC Health Services Research, Volume 13, No. SUPPL.2, Article S7, Year 2013
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Description
Introduction. Zambia's under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level. Description of implementation. The project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia's Lusaka Province. We have deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. We also engage community health workers to actively refer and follow up patients. Evaluation design. Project implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. Three annual household surveys will determine population estimates of age-standardized mortality and under-5 mortality in each community before, during, and after implementation. Surveys will also provide measures of childhood vaccine coverage, pregnancy care utilization, and general adult health. Health facility surveys will assess coverage of primary health interventions and measures of health system effectiveness. Discussion. The patient-provider interaction is an important interface where the community and the health system meet. Our project aims to reduce population mortality by substantially improving this interaction. Our success will hinge upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognize their value and begin to utilize them. © 2013 Stringer et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Stringer, Jeffrey S.A.
United States, Chapel Hill
Unc School of Medicine
Taylor, Angela
Zambia, Lusaka
Centre for Infectious Disease Research
Chibwesha, Carla J.
Zambia, Lusaka
Centre for Infectious Disease Research
Chi, Harmony F.
Zambia, Lusaka
Centre for Infectious Disease Research
Ayles, Helen Mary
Zambia, Lusaka
Zambart, Zambia
Manda, Handson
Zambia, Lusaka
Centre for Infectious Disease Research
Mazimba, Wendy
Zambia, Lusaka
Centre for Infectious Disease Research
Schuttner, Linnaea C.
Zambia, Lusaka
Centre for Infectious Disease Research
Sindano, Ntazana
Zambia, Lusaka
Centre for Infectious Disease Research
Williams, Frank B.
United States, Birmingham
The University of Alabama at Birmingham
Chintu, Namwinga T.
Zambia, Lusaka
Centre for Infectious Disease Research
Chilengi, Roma
Zambia, Lusaka
Centre for Infectious Disease Research
Statistics
Citations: 23
Authors: 12
Affiliations: 4
Identifiers
Doi:
10.1186/1472-6963-13-S2-S7
e-ISSN:
14726963
Research Areas
Health System And Policy
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Zambia