Potential of Integrated Continuous Surveys and Quality Management to Support Monitoring, Evaluation, and the Scale-Up of Health Interventions in Developing Countries

Alexander K. Rowe Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Search for other papers by Alexander K. Rowe in
Current site
Google Scholar
Restricted access

Well-funded initiatives are challenging developing countries to increase health intervention coverage and show impact. Despite substantial resources, however, major obstacles include weak health systems, a lack of reasonably accurate monitoring data, and inadequate use of data for managing programs. This report discusses how integrated continuous surveys and quality management (I-Q), which are well-recognized approaches in wealthy countries, could support intervention scale-up, monitoring and evaluation, quality control for commodities, capacity building, and implementation research in low-resource settings. Integrated continuous surveys are similar to existing national cross-sectional surveys of households and health facilities, except data are collected over several years by permanent teams, and most results are reported monthly at the national, province, and district levels. Quality management involves conceptualizing work as processes, involving all workers in quality improvement, monitoring quality, and teams that improve quality with “plan-do-study-act” cycles. Implementing and evaluating I-Q in a low-income country would provide critical information on the value of this approach.

  • 1

    Anonymous, 2008. The GAVI Alliance’s new vaccine strategy. Lancet 372 :2.

  • 2

    The Global Fund to Fight AIDS, Tuberculosis, and Malaria, 2008. How the global fund works. Available at: http://www.theglobalfund.org/en/about/how. Accessed May 27, 2008.

  • 3

    US Institute of Medicine, Committee for the Evaluation of the President’s Emergency Plan for AIDS Relief (PEPFAR) Implementation, 2007. PEPFAR Implementation: Progress and Promise. Washington, DC: National Academies Press.

  • 4

    Millennium Development Goals, 2005. Global data monitoring information system. Available at: http://www.developmentgoals.org/. Accessed November 2, 2005.

  • 5

    Roll Back Malaria Partnership, 2006. Roll back malaria global strategic plan 2005–2015. Available at: http://www.rollbackmalaria.org/forumV/docs/gsp_en.pdf. Accessed September 20, 2006.

  • 6

    The Bellagio Study Group on Child Survival, 2003. Knowledge into action for child survival. Lancet 362 :323–327.

  • 7

    Bryce J, el Arifeen S, Pariyo G, Lanata CF, Gwatkin D, Habicht J-P, and the Multi-Country Evaluation of IMCI Study Group, 2003. Reducing child mortality: can public health deliver? Lancet 362 :159–164.

    • Search Google Scholar
    • Export Citation
  • 8

    Sanders D, Haines A, 2006. Implementation research is needed to achieve international health goals. PLoS Med 3 :e186.

  • 9

    World Bank, 2004. The World Development Report 2004: Making Services Work for Poor People. New York: Oxford University Press.

  • 10

    Rowe AK, de Savigny D, Lanata CF, Victora CG, 2005. How can we achieve and maintain high-quality performance among health workers and managers in low-resource settings? Lancet 366 :1026–1035.

    • Search Google Scholar
    • Export Citation
  • 11

    World Health Organization, 2006. The World Health Report 2006: Working Together for Health. Geneva: World Health Organization.

  • 12

    Victora CG, Habicht J-P, Bryce J, 2004. Evidence-based public health: moving beyond randomized trials. Am J Public Health 94 :400–405.

    • Search Google Scholar
    • Export Citation
  • 13

    Walshe K, 2007. Understanding what works—and why—in quality improvement: the need for theory-driven evaluation. Int J Qual Health Care 19 :57–59.

    • Search Google Scholar
    • Export Citation
  • 14

    Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, de Waal A, Wibulpolprasert S, 2004. Human resources for health: overcoming the crisis. Lancet 364 :1984–1990.

    • Search Google Scholar
    • Export Citation
  • 15

    Gething PW, Noor AM, Gikandi PW, Ogara EAA, Hay SI, Nixon MS, Snow RW, Atkinson PM, 2006. Improving imperfect data from health management information systems in Africa using space-time geostatistics. PLoS Med 3 :e271.

    • Search Google Scholar
    • Export Citation
  • 16

    Mathers CD, Ma Fat D, Inoue M, Rao C, Lopez AD, 2005. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 83 :171–177.

    • Search Google Scholar
    • Export Citation
  • 17

    Murray CJL, Shengelia B, Gupta N, Moussavi S, Tandon A, Thieren M, 2003. Validity of reported vaccination coverage in 45 countries. Lancet 362 :1022–1027.

    • Search Google Scholar
    • Export Citation
  • 18

    Ronveaux O, Rickert D, Hadler S, Groom H, Lloyd J, Bchir A, Birmingham M, 2005. The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems. Bull World Health Organ 83 :503–510.

    • Search Google Scholar
    • Export Citation
  • 19

    Lim SS, Stein DB, Charrow A, Murray CJL, 2008. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. Lancet 372 :2031–2046.

    • Search Google Scholar
    • Export Citation
  • 20

    MEASURE DHS, 2006. Demographic and health surveys. Available at: http://www.measuredhs.com. Accessed December 3, 2006.

  • 21

    UNICEF, 2006. Multiple indicator cluster survey 3. Available at: http://www.childinfo.org/mics/mics3. Accessed December 3, 2006.

  • 22

    US Bureau of Labor Statistics, 2008. Internet website. Available at: http://www.bls.gov/. Accessed November 5, 2008.

  • 23

    Centers for Disease Control and Prevention, 2003. Behavioral risk factor surveillance system User’s guide. Available at: www.cdc.gov/brfss/usersguide.htm. Accessed August 27, 2003.

  • 24

    Centers for Diseases Control and Prevention, 2008. Internet website. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed May 27, 2008.

  • 25

    Soleman N, Chandramohan D, Shibuya K, 2006. Verbal autopsy: current practices and challenges. Bull World Health Organ 84 :239–245.

  • 26

    World Health Organization, Department of Child and Adolescent Health and Development, 2003. Health Facility Survey: Tool to Evaluate the Quality of Care Delivered to Sick Children Attending Outpatients Facilities (Using the Integrated Management of Childhood Illness Clinical Guidelines as Best Practices). Geneva, Switzerland: World Health Organization.

  • 27

    Korenromp EL, Arnold F, Williams BG, Nahlen BL, Snow RW, 2004. Monitoring trends in under-5 mortality rates through national birth history surveys. Int J Epidemiol 33 :1293–1301.

    • Search Google Scholar
    • Export Citation
  • 28

    Rowe AK, Steketee RW, Arnold F, Wardlaw T, Basu S, Bakyaita N, Lama M, Winston CA, Lynch M, Cibulskis RE, Shibuya K, Ratcliffe AA, Nahlen BL for the Roll Back Malaria Monitoring and Evaluation Reference Group, 2007. Methods for evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa. Trop Med Int Health 12 :1524–1539.

    • Search Google Scholar
    • Export Citation
  • 29

    Kuykendall RJ, 2000. County specific prevalence of regular physical activity in Georgia: a comparison of three analytic methods using Behavioral Risk Factor Surveillance System data. MS thesis, Rollins School of Public Health, Emory University, Atlanta, GA.

  • 30

    Howard G, Howard VJ, Katholi C, Oli MK, Huston S, 2001. Decline in US stroke mortality. An analysis of temporal patterns by sex, race, and geographic region. Stroke 32 :2213–2220.

    • Search Google Scholar
    • Export Citation
  • 31

    Berwick DM, Godfrey AB, Roessner J, 1990. Curing Health Care. San Francisco: Jossey-Bass.

  • 32

    Victora CG, Wagstaff A, Armstrong Schellenberg J, Gwatkin D, Claeson M, Habicht J-P, 2003. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet 362 :233–241.

    • Search Google Scholar
    • Export Citation
  • 33

    Murray CJL, Frenk J, 2008. Health metrics and evaluation: strengthening the science. Lancet 371 :1191–1199.

  • 34

    Garvin DA, 1988. Managing Quality: The Strategic and Competitive Edge. New York: Free Press.

  • 35

    Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP, 1996. The Improvement Guide. A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass.

  • 36

    Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB, 2007. Effectivness of teaching quality improvement to clinicians: a systematic review. JAMA 298 :1023–1037.

    • Search Google Scholar
    • Export Citation
  • 37

    Øvretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, McLeod H, Molfenter T, Plsek P, Robert G, Shortell S, Wilson T, 2002. Quality collaboratives: lessons from research. Qual Saf Health Care 11 :345–351.

    • Search Google Scholar
    • Export Citation
  • 38

    Institute for Healthcare Improvement, 2003. The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. Available at: http://www.ihi.org/ihi. Accessed October 27, 2008.

  • 39

    Berwick DM, 2004. Lessons from developing nations on improving health care. BMJ 328 :1124–1129.

  • 40

    Catsambas TT, Franco LM, Gutmann M, Knebel E, Hill P, Lin Y-S, 2008. Evaluating Health Care Collaboratives: The Experience of the Quality Assurance Project. Bethesda, MD: University Research Corporation.

  • 41

    The HIVQUAL Project, 2008. Country profile: HIVQUAL-Uganda pushes ahead at full speed. The HIVQUAL international update. Available at: http://www.hivguidelines.org/admin/Files/qoc/HIVQUAL/international%20update/HQIU_May_2008_epublication.pdf. Accessed October 21, 2008.

  • 42

    Reerink IH, Sauerborn R, 1996. Quality of primary health care in developing countries: recent experiences and future directions. Int J Qual Health Care 8 :131–139.

    • Search Google Scholar
    • Export Citation
  • 43

    Supawitkul S, Srisongsom S, Ningsanond P, Lolekha R, Fox K, Agins B, Levine W, Tappero J, Thanprasertsuk S, 2006. Quality improvement of HIV care in Thailand through the HIVQUAL-T model, 2002–2005. XVI International AIDS Conference 2006, 13–18 August 2006, Montreal, Canada.

  • 44

    Weinberg M, Fuentes JM, Ruiz AI, Lozano FW, Angel E, Gaitan H, Goethe B, Parra S, Hellerstein S, Ross-Degnan D, Goldmann DA, Huskins C, 2001. Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods. Arch Intern Med 161 :2357–2365.

    • Search Google Scholar
    • Export Citation
  • 45

    Withanachchi N, Karandagoda W, Handa Y, 2004. A performance improvement programme at a public hospital in Sri Lanka: an introduction. J Health Organ Manag 18 :361–369.

    • Search Google Scholar
    • Export Citation
  • 46

    Withanachchi N, Handa Y, Karandagoda KKW, Pathirage PP, Tennakoon NCK, Pullaperuma DSP, 2007. TQM emphasizing 5-S principles: a breakthrough for chronic managerial constraints at public hospitals in developing countries. Int J Public Sector Management 20 :168–177.

    • Search Google Scholar
    • Export Citation
  • 47

    Roethlisberger FJ, Dickson WJ, 1939. Management and the Worker: An Account of a Research Program Conducted by Western Electric Company, Hawthorne Works, Chicago. Cambridge, MA: Harvard University Press.

  • 48

    Guerra CA, Gikandi PW, Tatem AJ, Noor AM, Smith DL, Hay SI, Snow RW, 2008. The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLoS Med 5 :e38.

    • Search Google Scholar
    • Export Citation
  • 49

    Kaur H, Goodman C, Thompson E, Thompson K-A, Masanja I, Kachur SP, Abdulla S, 2008. A nationwide survey of the quality of antimalarials in retail outlets in Tanzania. PLoS One 3 :e3403.

    • Search Google Scholar
    • Export Citation
  • 50

    Smith SC, Joshi UB, Grabowsky M, Selanikio J, Nobiya T, Aapore T, 2007. Evaluation of bednets after 38 months of household use in Northwest Ghana. Am J Trop Med Hyg 77 (Suppl 6):243–248.

    • Search Google Scholar
    • Export Citation
  • 51

    Loevinsohn B, Harding A, 2005. Buying results? Contracting for health service delivery in developing countries. Lancet 366 :676–681.

  • 52

    Siddiqi S, Masud TI, Sabri B, 2006. Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region. Bull World Health Organ 84 :867–875.

    • Search Google Scholar
    • Export Citation
  • 53

    Meessen B, Musango L, Kashala J-PI, Lemlin J, 2006. Reviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda. Trop Med Int Health 11 :1303–1317.

    • Search Google Scholar
    • Export Citation
  • 54

    Yamada T, 2008. In search of new ideas for global health. N Engl J Med 358 :1324–1325.

  • 55

    Alliance for Health Policy and Systems Research, 2008. Internet website. Available at: http://www.who.int/alliance-hpsr/en/. Accessed November 5, 2008.

  • 56

    Global Health Workforce Alliance, 2008. Internet website. Available at: http://www.ghwa.org/. Accessed November 5, 2008.

  • 57

    Health Metrics Network, 2008. Internet website. Available at: http://www.who.int/healthmetrics/about/en. Accessed October 27, 2008.

  • 58

    Institute for Health Metrics and Evaluation, 2008. Internet website. Available at: http://www.healthmetricsandevaluation.org/. Accessed October 27, 2008.

  • 59

    Institute for Healthcare Improvement, 2008. Internet website. Available at: http://www.ihi.org/ihi. Accessed October 27, 2008.

  • 60

    International Household Survey Network, 2008. Internet website. Available at: http://www.internationalsurveynetwork.org/home/. Accessed October 27, 2008.

  • 61

    International Network for Rational Use of Drugs, 2008. Internet website. Available at: http://www.inrud.org/. Accessed November 5, 2008.

  • 62

    Partnership in Statistics for Development in the 21st Century. 2008. Internet website. Available at: http://www.paris21.org/. Accessed October 27, 2008.

  • 63

    World Alliance for Patient Safety, 2008. Internet website. Available at: http://www.who.int/patientsafety/en/. Accessed November 5, 2008.

  • 64

    Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, and the Bellagio Child Survival Study Group, 2003. How many child deaths can we prevent this year? Lancet 362 :65–71.

    • Search Google Scholar
    • Export Citation
  • 65

    Morel CM, Lauer JA, Evans DB, 2005. Cost effectiveness analysis of strategies to combat malaria in developing countries. BMJ 331 :1299.

  • 66

    Rowe AK, Steketee RW, 2007. Predictions of the impact of malaria control efforts on all-cause child mortality in Sub-Saharan Africa. Am J Trop Med Hyg 77 (Suppl. 6):48–55.

    • Search Google Scholar
    • Export Citation
  • 67

    Skarbinski J, Winston CA, Massaga JJ, Kachur SP, Rowe AK, 2008. Assessing the validity of health facility-based data on insecticide-treated bednet possession and use: comparison of data collected via health facility and household surveys—Lindi Region and Rufiji District, Tanzania, 2005. Trop Med Int Health 13 :396–405.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 30 30 10
Full Text Views 258 83 0
PDF Downloads 118 37 0
Membership Banner
Affiliate Membership Banner
Research for Health Information Banner
Society Publishers Coalition Banner