Lessons learned from approaches to improve the case management of sick children in a quality assurance environment in Niger Niger February 1998.

This report pertains to a consultant visit to Niger during February 1998 for improving quality in managing sick children and describes the lessons learned from approaches to improve health worker performance in a quality assurance (QA) environment. Improvements were the result of following general QA principles and systematic monitoring of technical and managerial competence. Recommendations made include a supervisory checklist with valid and reliable indicators of QA. The checklist helps with immediate problem solving with monitoring service quality by district health teams and with conducting participatory reviews and activity planning. In Niger the capacity could serve as a regional training site for improving performance among health managers and trainers from other African countries. Health workers and district health teams were trained in QA methods since 1993. Each facility has at least 1 QA team which successfully completed 1-2 problem solving cycles over the past 2-3 years. Each step of the problem solving cycle takes at least 3-12 months to complete. Problem solving relies on available information and subjective observations. Health workers undergo a rapid health worker performance assessment. Health workers perceived a great need for clear service standards and welcomed the monitoring of technical and managerial competence. It was learned that QA with a structured monitoring approach contributed to improved case management by clearly identifying standards of care. The checklist identified specific service problems and needs and led to action.