Malawi: Successfully Strengthening Quality Management and HMIS

EPOS Health Management successfully finished technical assistance support to the projects “Strengthening of Quality Management Structures in the Malawian Healthcare System with a Focus on Reproductive Health” and “Strengthening of the Malawian Health Management Information System at National and Decentralized Level” that were implemented on behalf of GIZ from November 2013 – December 2016 within the frame of the overall Malawi German Health Programme.

A final workshop was held last December in Lilongwe with all major stakeholders from national, district, zonal and facility levels as well as representatives of GIZ and other financing organisations. Final reports that summarise project achievements were submitted to GIZ at the start of this year.

The quality management (QM) project operated at several levels to improve the quality of health service delivery in line with the integrated national standards for Sexual and Reproductive Health (SRH)/ Family Planning (FP) and Infection Prevention (IP).

At national level, advisory services were offered to strengthen quality management structures at the Ministry of Health (MoH) by assisting in setting up and institutionalising a quality assurance (QA)  Directorate at the MoH. This included the development of a concept note for the development of a QM Secretariat and terms of reference for its members and specific job descriptions for the Head of the Secretariat, a QM Development Officer and a QA/ Quality Improvement (QI) Technical Officer as well as support in the development of a National QM Policy and Strategic Plan.

The  MoH was supported in implementing a mentorship project at selected district hospitals and health centres to develop capacity and enhance the knowledge and skills of health workers like nurses/ midwives and clinicians in providing quality Emergency Obstetric and Newborn Care (EmONC) services.

At district level, capacity building focused on establishing a pool of QA trainers through training of trainers (ToT) and QI coaches who could subsequently train other service providers and coach QI teams in the targeted health facilities. Support was provided for the establishment of functional Quality Improvement Teams (QITs) through capacity building and coaching. Managers and service providers were trained in the basic concept, tools and techniques of quality assurance. At the end of the project, QI teams were functional in all the 14 BEmONC sites and in some MNH departments at the CEmONC sites.

Within the frame of the health management information system (HMIS) project at national level, EPOS assisted the Central Monitoring and Evaluation Division (CMED) in the process of integrating existing health information systems and data sources into a central-level ‘data warehouse’, thus creating an integrated health information system with the capacity to differentiate data, taking into account various socioeconomic factors. Health service managers at all levels were enabled to increasingly use improved data of high validity for evidence-based decision-making, the identification of quality deficiencies, and planning purposes.

Capacity building was provided for M&E staff at national (CMED) and decentralised level (i.e.: Zonal Health Support Offices and District Health Management Teams (DHMTs) as well as selected district hospitals and primary health care facilities within the four target districts Balaka, Dedza, Mchinji, and Ntcheu). Services at national level, moreover, comprised support to the revision of the national HIS policy, strategy and guidelines, the revision of the indicators included in the HMIS / DHIS 2.0 system and of data collection tools. EPOS further assisted the CMED and the M&E technical working group on national data standards in the development of a national strategy for data integration.

At decentralised level, EPOS assessed the quality of data collected, provided capacity building for district level HMIS staff, developed and implemented an operational plan for supportive supervision for HMIS, and assisted district HMIS officers to carry out bi-annual rounds of data quality audits. DHMTs, statistical clerks, health workers (facility in-charge, HMIS focal person, health surveillance assistants) and clinical personnel (68 in total) were sensitised to the reporting requirements of HMIS and trained in HMIS with a focus on data sources, data collection, data management and documentation, case definitions, and data quality as well as reporting and interpretation. A data use culture was promoted amongst the staff (DHMTs, programme coordinators, department heads and in-charges) for decision making. This also included sensitisation to the importance of using quality, completeness and timeliness of data for decision making in order to improve the life of the community.