Implementation of quality improvement for community-based health services: what worked, what didn’t, and why? A case study in Ethiopia

Background: Recently, there has been a growing interest in quality improvement (QI) interventions to enhance the health care services provision. However, applying QI interventions to community-based health services (CBHS) is still a limited practice. Strengthening Ethiopia’s Urban Health Program (SEUHP), implemented by John Snow, Inc., used QI principles to address certain challenges in the implementation of the urban health extension program (UHEP). QI activities aimed to improve referral systems between the UHEP and health centers (HCs), strengthen the defaulter tracing system, and enhance linkages and integration between facility-based primary health services and community-based extension services. Aim: This case study reviews the implementation and documents lessons learned from the SEUHP QI intervention. Method: Assessment and multiple case study design to review the implementation and document lessons learned. The study reviews multiple data sources and qualitatively analyzes the experience of QI teams (QIT) in different regions in Ethiopia. Findings: The functionality of the QIT varies across the regions. Where QI interventions function, demand for specific health services increased and QITs met targeted improvement objectives. The linkage and integration between the community-based UHEP extension services and facility health services improved as the result of QI intervention. Conclusion: This case study provides evidence that, despite challenges, QI interventions can be an important tool for facilitating health services. Functional QITs helped motivate Urban Health Extension Professionals (UHE-ps) to effectively execute their job. The QIT’s commitment, the regularity of QIT meetings, and the engagement of all staff and community groups are key factors in the successful implementation of QI initiatives that resulted in improved quality of service provision. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):54-61] Keywords: Quality Improvement, Community, Urban Health, Ethiopi