QUALITY ASSURANCE PROJECT EVALUATION REPORT The Niger QAP/BASICS Joint Project Final Evaluation Center for Human Services • 7200 Wisconsin Avenue, Suite 600 • Bethesda, MD 20814-4811 • USA The Niger QAP/BASICS Joint Project Final Evaluation Stephane Legros, MD, MPH Youssef Tawfik, MD, MPH Xavier Crespin, MD, MPH Mamoudou Djingarey, MD, MPH Elizabeth Goodrich Hany Abdallah, MHS Quality Assurance Project 7200 Wisconsin Avenue, Suite 600 Bethesda, MD 20814-4811 301-654-8338, FAX 301-941-8427 www.qaproject.org Acknowledgements Recommended citation The evaluation team is indebted to the staff of the QAP/ Legros, S., Y. Tawfik, X. Crespin, M. Djingarey, E. BASICS project for their technical assistance throughout Goodrich, and H. Abdalah. 2000. The Niger QAP/ the mission and for the secretarial help, transport, and BASICS Project: Final evaluation. Evaluation Report equipment they made available throughout the mission. 1(1). Published for the United States Agency for The team also appreciates the willingness of the local International Development (USAID) by the Quality provincial and district health authorities in the Tahoua Assurance Project (QAP): Bethesda, Maryland. and Dosso Departments to be available at all times. The evaluation team acknowledges the support provided by the USAID Mission in Niamey in funding this final evaluation and thanks the Agency for providing the About this series Quality Assurance Project with the opportunity to The Evaluation Report series presents the findings, contribute to the success of the QAP/BASICS project in recommendations, and lessons learned of completed the Tahoua and Dosso Regions of Niger. The evaluation quality assurance (QA) evaluations in countries with team’s work was supported through the Center for long-term QA programs. An electronic copy of this Human Services (USAID Contract No. HRN-C-00-96- publication may be found at [email protected]. 90013) and the BASICS project (USAID Contract No. HRN 6006-C-00-3031-00). © Center for Human Services (CHS), 2000 Table of Contents List of Tables and Figures .............................................................................................................................................. iv List of Appendices and Appendix Maps, Tables, and Figures .......................................................................................... v Abbreviations and Acronyms ......................................................................................................................................... vi Abstract ....................................................................................................................................................................... viii Executive Summary ....................................................................................................................................................... ix I. Introduction ............................................................................................................................................................. 1 1. QAP/BASICS Project Activities ......................................................................................................................... 1 2. Pre-Project Assessment ....................................................................................................................................... 2 3. Results Summary ................................................................................................................................................ 2 4. Cost Recovery .................................................................................................................................................... 3 II. Final Evaluation: Objectives of the QAP/BASICS Project ....................................................................................... 4 1. Evaluation Background ....................................................................................................................................... 4 2. Evaluation Summary ........................................................................................................................................... 5 3. Evaluation Method ............................................................................................................................................. 5 4. Evaluation Report Structure ................................................................................................................................6 5. Limits of the Project Evaluation .......................................................................................................................... 6 III. Institutionalization of the QA Concept (TAP Objective Number 1) .......................................................................... 7 1. Standards: Background ....................................................................................................................................... 7 2. Implementing and Monitoring Standards ............................................................................................................ 8 3. Quarterly Meetings ........................................................................................................................................... 10 4. QA Cycles and Process Improvement ............................................................................................................... 11 5. Process Design/Redesign .................................................................................................................................. 15 6. Results Analysis ................................................................................................................................................ 15 7. Results from Case Studies ................................................................................................................................. 17 8. Results from Focus Groups ............................................................................................................................... 21 IV. QAP/BASICS: Applying QA Measures to Introduce IMCI (TAP Objective Number 2) ........................................ 22 1. Development and Communication of IMCI Guidelines ..................................................................................... 22 2. Local Implementation ....................................................................................................................................... 23 3. Applying QA Measures to Introduce IMCI ....................................................................................................... 25 V. Disseminating the Techniques and Results of QA ................................................................................................. 31 1. Dissemination during QAP ............................................................................................................................... 31 2. International Dissemination of QAP/BASICS ................................................................................................... 31 3. QA/IMCI Dissemination ................................................................................................................................... 31 4. Niamey Conference, October 26-28, 1998 ........................................................................................................ 31 VI. Costs of the QAP/BASICS Project Activities ......................................................................................................... 32 1. Approach .......................................................................................................................................................... 32 2. Basic QA and IMCI Training ............................................................................................................................ 33 3. Training of Trainers .......................................................................................................................................... 34 4. Team-Based Problem Solving ........................................................................................................................... 34 5. Supervision and Coaching Activities ................................................................................................................. 35 6. Supervision Checklist ....................................................................................................................................... 37 7. Recommendations Relating to Supervisory and Coaching Costs ....................................................................... 37 8. Quality Meetings .............................................................................................................................................. 37 9. Cost of Sustaining Essential QA Activities ........................................................................................................ 38 VII. Conclusions/Recommendations ............................................................................................................................. 38 1. Conclusions ...................................................................................................................................................... 38 2. Lessons Learned ............................................................................................................................................... 39 3. Main Factors Limiting QA ................................................................................................................................40