To describe the development of Quality Improvement (QI) capacity in communities and health facilities and its application to improve women’s use of ANC and essential nutrition actions (ENA) to prevent or treat anemia.
We conducted baseline (November 2013) and end-line (December 2015) QI capacity assessment with 89 community and 96 health facility QI team members. The assessment elicited perceived QI capacity: know how, have done, can lead others and can apply to new areas. We calculated mean Likert scale scores (1 to 5) and paired t-tests to assess differences in perceived capacity. We assessed trends in ANC use and ENA using monthly data from QI database.
There were significant improvements in perceived capacity for team organization (1.1 to 4.1), setting aim statements (1.1 to 4.0), using data for decision-making (1.0 to 4.0), testing solutions (1.1 to 4.1). The overall results reflected increased QI capacity (know how (1.1 to 4.0); have done (1.0 to 3.8); can lead others (1.0 to 3.9); and can apply to new areas (1.1 to 4.3)). Successful solutions to improve ANC use and ENA included client testimony, teaching anemia recognition and prevention, and following up on drug supply and distribution. Women’s use of ANC increased from 28% (2013) to 90% (2015) of the expected number of pregnant women; more than 12,000 women had at least one ANC visit; of these, 95% received iron folate and 42% received Mebendozole.
Communities and health care providers can, together, apply continuous QI methods to significantly improve ANC use and maternal nutrition.