Expanded Quality Management Using Information Power, EQUIP

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EQUIP: Expanded Quality Management Using Information Power  
 
 
 
 
 
4: Implementation of the EQUIP Continuous Survey 
 
Background: Why do continuous surveys? 
The lack of high quality, timely data for evidence-informed decision making at the district level presents a challenge to knowing 
what works to improve maternal and newborn survival in low-income settings. To address this problem, EQUIP implemented 
district-level continuous household and health facility surveys in Uganda (Mayuge and Namayingo districts) and Tanzania 
(Tandahimba and Newala districts) for the continuous feedback of data to the districts, both to support quality improvement 
teams and to evaluate the quality improvement intervention.  
Method: What did EQUIP plan to do? 
Continuous survey data were used for quality improvement in the intervention districts and for effect evaluation of the 
intervention. Over the 30 months of intervention (November 2011 to April 2014), EQUIP conducted continuous cross-sectional 
household and health facility surveys using independent probability samples of household clusters to represent each district 
each month, and repeat censuses of all government health facilities.  All resident women aged 13–49 years (15–49 in Uganda) in 
selected households were interviewed about recent live births and use of health services (Photo 1). Geographical positioning 
was collected for all respondents for subsequent spatial 
analysis. Using repeat samples in this way allowed data to 
be aggregated at six four-monthly intervals to track 
progress over time for evaluation, and for continuous 
feedback to quality improvement teams in intervention 
districts. 
In both countries, one continuous survey team of eight 
people was employed to interview approximately 300 
households, 10 health facilities, and complete 10 health 
worker interviews per district, per month. Data were 
collected using personal digital assistants. After every  four 
months of data collection, routine tabulations of all 
indicators were produced and synthesized into report 
cards (see overleaf) for use to support decision making by 
the EQUIP quality improvement teams.    
 
Results: What did EQUIP achieve? 
The continuous surveys were implemented as planned. Completion of household interviews was consistently over 90% in both 
countries. Indicators across the continuum of care for mothers and newborns were tabulated every four months, the results 
were summarized and were discussed by the quality improvement teams. However, due to the limited sample size (to limit 
costs) report cards could only show district estimates but not estimates for the respective target populations of each health 
facility. At the end of the intervention period, the same data were used for the impact evaluation.  
 
Conclusion 
The continious surveys were feasible and provided high quality data throughout the EQUIP implementation period which were 
use for regular feed-back to the teams. 
 
For further information contact: Tanya Marchant (tanya.marchant@lshtm.ac.uk) and Joseph Akuze 
(Joseph2.Akuzewaiswa@live.uwe.ac.uk) ; Peter Waiswa (pwaiswa@musph.ac.ug) in Uganda; and Yovitha Sedekia 
(ysedekia@ihi.or.tz) or Fatuma Manzi (fmanzi@ihi.or.tz) in Tanzania 
Photo 1. Performing a survey 
EQUIP: Expanded Quality Management Using Information Power  
 
 
 
 
 
“Community teams felt 
highly motivated by 
seeing data from their 
own areas.” 
 
Using Report Cards for Feedback and Action 
Background: The use of report cards to stimulate action 
Both quality improvement and health system strengthening programs need health data as the basis for decision-making, 
planning, and monitoring. High quality population data on health outcomes are rarely available at the local level. The continuous 
household and health facility surveys implemented by EQUIP produced high quality real-time, district-specific data, which we 
summarised every three-to-four months for district, health facility, and community quality improvement teams using ”report 
cards”. We used reports card to introduce new topics for quality improvement during the 
learning sessions and, at the district level, to discuss progress. 
Methods: What did the report cards look like? 
Report cards were specifically adapted for three different levels of care. The community 
report cards included very few indicators and used a simple graphical display for ease of 
being understood by community quality improvement teams (Figure 1). Content of report 
cards was tailored to the interests of quality improvement teams and designed to trigger 
action. 
The health facility and district report cards used bar charts and run-
charts, which also allowed the indication of trends over time or 
levels in different parts of the district (Figure 2). 
The use of the report cards was supported by the EQUIP team. The 
report cards were introduced during learning sessions and 
indicators were explained: how they were constructed; which 
questions were asked of respondents; and which limitations the 
indicators had. 
This explanation led to discussions on the reliability of many 
common indicators. This process also built capacity to interpret 
indicators for monitoring of maternal and newborn health at the 
district level.   
 
 
Conclusion: What did we learn? 
The report cards were met with high interest at the 
community, health facility, and district levels and were able 
to trigger attention for neglected areas of health care. Help 
with interpretation of indicators was important so that 
improvement teams understood what the data could tell 
them.  The capacity to interpret population- and facility-
based data improved over time but required considerable 
facilitation by project staff. 
 
 
 
For further information contact:  
Tanya Marchant (tanya.marchant@lshtm.ac.uk); Peter Waiswa (pwaiswa@musph.ac.ug) in Uganda; and Yovitha Sedekia 
(ysedekia@ihi.or.tz) or Fatuma Manzi (fmanz,i@ihi.or.tz) in Tanzania 
Figure 1: Community report cards used during a learning session 
to introduce infection prevention 
Figure 2: District and health facility report cards on knowledge of danger signs 


Expanded Quality Management Using Information Power (EQUIP): Implementation of the EQUIP Continuous Survey

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