The Quality Measuring Tool (QMT) for Reproductive Health ServicesTool Name: The Quality Measuring Tool (QMT) for Reproductive Health Services Origin /Source: developed by Engender Health (formerly known as AVSC International), in 1995 and first used in collaboration with the Tanzania Ministry of Health and Family Planning Association of Tanzania (UMATI). EngenderHealth is currently de veloping a global version. Technical Area: Maternal health To Tool (Forthcoming at http://www.engenderhealth.org) Basic Description: A participatory, practical, self-assessment tool for staff and supervisors to evaluate the quality of reproductive health services at the site level. The indicators are based on the self-assessment guides in COPE®, and foc us on family planning, maternal care, gynecology, and STI/HIV services as well as emergency care and infection prevention practices. Indicators are organized according to the seven clients' rights and three providers' needs, as in COPE®. Each "yes" an swer is worth one point, and each "no" equals zero points. Sites calculate a score for each of the clients' rights and providers' needs and measure their progress over time. This tool is intended for use on an annual basis to complement the more frequent use of COPE® and other ongoing quality improvement activities. Country Applications: The QMT was piloted in 93 sites in Tanzania from 1995-1999. Since then it has been used in Russia (adapted for adolescent reproductive health services) and is currently being translated into Arabic for use in Jordan. Language(s) Available: Currently available in English and in Russian. Soon to be available in Arabic. Purpose: Assessment Technical Scope/Purpose: Site level information is collected to assess key indicators of the quality of family planning, maternal care, gynecology, and STI/HIV and emergency care services in addition to proper infection prevention practices. Design: Site staff and their supervisor(s) discuss each question together and agree on their answer, scoring 1 point for a "yes" and zero points for a "no" answer. Some questions involve reviewing site records and observing the presence and condition of specific equipment, drugs and other supplies. Method: Qualitative and quantitative Frequency of Administration: Recommended for use on an annual basis to measure improvement over time. This tool builds on other more frequent quality improvement activities at the site level, including facilitative supervision and medical monitoring, COPE® exercises, training, and other activities. Key Users of the Information: Primary users: site staff and internal and external supervisors of healthcare facilities. Secondary: regional or national level supervisors or program coordinators. Objectives and Scope of the Tool: General objectives at site level: to identify and prioritize changes needed to improve service delivery, and to involve and motivate staff to improve quality through a participatory process of measuring progress over time. Specific objectives at site level: to assess key indicators of family planning, maternal care, gynecology, STI/HIV and emergency care and infection prevention practices. General objectives at program level: when the tool is used in several sites within a program or country, it gives program managers an overview of the quality of services provided, and aids in identifying systemic needs or trends (e.g., shortages of specific supplies throughout a region, or improvements in supervision throughout a program). Key Indicators: Indicators are organized according to each of the clients' rights as follows:
And according to the providers' needs:
Within each of the elements of quality services, there are questions related to specific services. Examples of indicators related to maternal and newborn care are:
Other indicators measure the availability of essential emergency drugs and equipment, essential equipment for decontamination, and essential equipment for disposal of medical waste and sharps. Tool Design: The assessment requires up to one and one-half days at a site, including time to orient site managers and staff, collect the data and analyze the results. The number of sites conducting the assessment varies, depending on site or program interest. Site staff and their supervisors should try to administer the QMT once a year, preferably during the same month each year. In between times, other quality improvement tools can be used. Technical assistance is required to introduce the tool and orient supervisors and staff to the process, but the tool is designed so that site staff and their supervisors can learn to collect and analyze the information without the need for ongoing external assistance. Data is owned and used foremost at the site level, but can be aggregated and analyzed at the regional or national level, by higher level supervisors or managers. In that case, data can be entered into a statistical spreadsheet or database. Depending on the sites or program using the tool, partners may include the Ministry of Health (local staff as well as higher level supervisors) and NGO healthcare facilities (and institutional headquarters if applicable). Implementation and Training: The first step is a site visit to orient the site management, and to orient and prepare all the staff who will be involved (about 2 hours). The data collection could take from 3 hours to a full day, depending on the number and experience of the participants, and how the data collection fits in with their other work tasks. Following the data collection is a meeting with staff (about 2 hours) to review the results and develop an action plan. Manuals and Guidelines (if applicable): The Quality Measuring Tool (QMT) for Reproductive Health Services: A manual for using the Quality Measuring Tool for healthcare managers and supervisors. Data Processing and Analysis: Site staff calculate their scores, and develop bar graphs of their scores, which they can compare from one year to the next. If desired, the results from several sites can be aggregated and analyzed by higher level program administrators either with a spreadsheet software (such as Lotus or Excel) or the data can be coded and entered into SPSS for more sophisticated analysis. Reporting and Dissemination of Results (if applicable): This depends on the needs of the sites or programs implementing the tool. At a minimum, results should be disseminated to all the site staff who participated in the evaluation (this takes place during the meeting with staff following the data collection), as well as to any higher level supervisors whose support may be needed to address particular site or systemic needs. Cost: This tool can be integrated into existing program and site level supervisory and quality improvement activities at the local level. If such activities are not already a part of program plans, then some donor funding may be required for the initial introduction of the tool, but donor funding is not necessary for the ongoing use of the tool at the site level. Lessons from Experience: Facilitation of the assessment: It is important that supervisors and managers encourage site staff to be open and honest about discussing site problems during the assessment. This requires that supervisors be facilitative rather than controlling or punitive. It is also important to link this assessment to other quality improvement activities that involve site staff in improving the quality of services. Timing: Set a date for the assessment, bearing in mind that it should be a time when the senior site staff will be available to participate, and during a month suitable for annual replication. If several sites are conducting the assessment, try to find a period (such as 1-3 months) in which all the sites can collect the data, to enable better comparisons across sites. Adapting the tool: The QMT is based on international standards of quality care, but should be adapted to reflect the local service delivery standards. The tool is designed to include a combination of minimum and ideal standards in order to allow room to measure improvement over a period of a few years. In order to measure change between a baseline and follow up assessments, the indicators must remain the same. Likewise, if comparisons or trends are to be measured between sites, the indicators me asured must be the same. However, the instrument could be revised again, after the initial few-year-period to reflect a higher standard of quality by that time. Contact: |