Monitoring, Evaluation and Research (MER) is taking center stage this week in Nairobi, Kenya, as MCHIP and Jhpiego co-host an MER workshop for colleagues based around the world. Seventy-two participants from 28 countries are spending this week together networking, learning best practices, and applying strategies for strengthening MER at the country-level. 
 
Measuring quality of care at the facility-level was just one of the sessions held on Day 1 of the workshop. I was pleased to present on experiences within Malawi, a country in which I work on behalf of MCHIP. I was able to share with the group a 2009 national quality improvement evaluation to measure the impact of Jhpiego’s standards-based management and recognition (SBM-R) approach for improvement of reproductive health and infection prevention practices.

SBM-R sets evidence-based performance standards and then empowers health care managers and providers to assess and address gaps between actual and desired performance at their facility (Necochea and Bossemeyer, 2005). The approach is well suited to low-resource settings like Malawi because it is facility based and focuses on practical solutions, requires little additional manpower or resources, helps transfer learning and motivate health workers, and results in steady improvements. In Malawi, SBM-R for infection prevention (IP) began in 2001 followed by the implementation of SBM-R for reproductive health in 2004, in an effort to contribute to the reduction of maternal morbidity and mortality which ranked as one of the highest in the world (984 per 100,000 according to the 2004 Demographic and Health Survey).

Both initiatives have since scaled up to all 23 District Hospitals and 33 of 584 Health Centers in the country. Results of the evaluation indicated a significant difference in the delivery of quality infection prevention practices and family planning and postnatal care services in the SBM-R intervention sites compared to the non-intervention sites. A review of service statistics also suggests that the SBM-R intervention increased the number of Cesarean sections, but showed no impact on other indicators of service utilization and skilled care. Based on these findings, it was concluded that SBM-R providers a positive, workable, low-cost, facility-driven approach to improve quality of IP practices and reproductive health services in Malawi and should be scaled-up. The presentation ended with a few key implications for SBM-R in Malawi which include a renewed effort to strengthen routine data collection systems in order to monitor reproductive health outcomes in lieu of conducting expensive national evaluations.
 

The SBM-R evaluation hit close to home for all the participants as every country representative who attended the session is implementing SBMR in some capacity. Participants were eager to learn about how to apply measures for evaluating SBM-R in their home countries. While the MER Unit in Baltimore continues to explore and develop field guidance on SBM-R evaluation, participants were encouraged to begin to put into place rigorous M&E systems to monitor client outcomes through routine analysis of service statistics. I am excited to hear more from my colleagues this week about their experiences in country and learn from them so we can continue the fight to deliver quality care so that we keep mothers and their babies healthy.
 
Aleisha Rozario
Monitoring & Evaluation Advisor
MCHIP/Jhpiego Malawi