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Enhancing quality assessment instruments within Senegal’s Performance Based Incentives program

Photo of Mother and child at their home in Nigeria

Research Overview

Senegal’s Ministry of Health and Social Affairs (MOH), with support from USAID, launched a pilot performance based incentives (PBI) program in 2012  with a focus on maternal, newborn and child health and infectious disease.* The PBI program incentivizes improvements in health quality and health outcomes in the low-resource context of Senegal’s health system, with a goal of motivating health workers and strengthening the capacity of district health teams to better meet incentivized targets. The RBF program rewards performance of health centers and providers based on the quantity of services provided, adjusted for a quality of care rating at the service delivery level. 
 
The MOH has recently pushed to improve the quality of care assessment instrument (QCAI) checklist to include process and results indicators that are more within providers’ scope of control (e.g. from indicators related to infrastructure or staffing to indicators related to patient safety and equipment maintenance).  The updated QCAI is comprised largely of structural indicators of quality. The MOH is interested in further updating it to include more process and outcome indicators, which are a more optimal measure of quality. In addition, the MOH hopes to develop a checklist for use in hospital settings (the existing QCAI is applied only in primary care settings – health centers and health posts). 
 
This study aims to enhance the primary care QCAI to capture broader measures of quality of care. In addition, the study team will support the MOH in designing a secondary care QCAI, with a focus on essential obstetric and neonatal care indicators (EONC). These modifications to the existing QCAI aim to reflect provider, patient, and clinical perceptions of quality of care, and will be used to determine distribution of reward payments to providers and facilities. Further, this study will focus on process documentation in terms of the QCAI revision and development process, and will examine the implementation of the QCAI checklists in both primary and secondary care settings, with a focus on the structures and processes that must be in place to effectively use a QCAI. 
 

Project Location


This study takes place in Kaffrine, Kolda, Tambacounda, Kedogou, Sedhiou, and Ziguinchor districts, Senegal

Research Objectives

This study has three primary research objectives:
  • To revise the existing primary care QCAI and to design the secondary care QCAI to include provider, patient, and clinical perceptions of quality.
  • To document best practices for implementing a QCAI in primary and secondary care facilities. 
  • To determine the effect of a quality assessment mechanism on service provision and utilization.
Enhancement of the existing primary care checklist will include analysis of QCAI scores from the two pilot regions, using EONC services as indicators. Analysis will identify trends and outliers in quality scores over time and by facility. Existing checklist items will be compared to national norms and international standards. Interviews with providers will examine health worker perspectives on the checklist items. 
 
To support development of the hospital-level QCAI, the study team will assist the MOH in determining which factors should be included in the checklist, as well as how QCAI scores will be verified and rewarded. The study team will pilot, monitor, and evaluate the implementation of the secondary care QCAI.
 
In order to examine the impact of the QCAI on provider behavior and perspectives, focus group discussions (FGDs) and in-depth interviews (IDIs) with providers in both pilot and non-pilot districts will be conducted. IDIs and FDGs will focus on barriers and facilitators to improving quality in the current QCAI system, best practices for improving quality of care, and understanding what motivates providers to change behaviors and how after exposure to a PBI system.   
 

Research into Action

This study is an example of a close research collaboration with the MOH and the PBI program partners to improve program processes through implementation science. Enhancements to Senegal’s QCAI checklist will be used in the expanding RBF program, and the findings on provider behavior will contribute to the evidence gap on the effect of PBI programs on provider behavior. 

Research Partners

 

Principal Investigators

 

Project Status

*Programme National du Financement Basé sur Ies Résultats

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