Clinical care providers, including Fatimata Bouré, Dr. Habib Doucara, Dr. Mariam Cissé, and Oumou Diabaté (left to right), brainstorm measurable goals to address gaps in health care delivery at the clinic level.
Mali has some of the world’s highest newborn, child, and maternal mortality rates in the world. This means that the communities Muso partners with connect to a health system at the epicenter of a global health crisis. When a patient walks through the door of the clinic, they put their health into the hands of clinical health care professionals. The work of clinical health care providers and staff is critical in our collective responsibility to end preventable deaths for our patients. To that end, it is crucial that they receive the necessary support and resources to deliver quality, evidence-based care to patients when they need it most.
This January, Muso launched a new Clinical Quality Improvement (CQI) initiative with a district hospital and community health center in peri-urban Mali. The initiative is designed to use global best practices to support quality of care in clinical health services. As a model designed for implementation by governments at scale, this new initiative is built to create ripple effects in the ways care providers address structural challenges in care provision, and establish a framework to ensure quality of clinical care.
Community Health Workers in Muso’s Proactive Care model are frontline providers connecting patients to an integrated continuum of care, from the household to the community health center, to the district hospital and tertiary hospitals. At the health facility level, Muso collaborates with government-run health centers to deliver free, universal care. For more than a year, we have worked with our public sector partners in Mali to build off of Mali’s national strategic plan for health care quality improvement, and adapt existing global CQI best practices to our context. Together we built a CQI approach that supports continuing medical education for public sector providers and through which clinical providers identify opportunities to improve clinic systems to make it easier to provide quality care.
We designed this CQI initiative by learning from our partners in the field. In late 2018, Muso launched an internal working group to establish a scalable, evidence-based CQI system for Muso’s Proactive Care model. This interdisciplinary group came together to study best practices from CQI systems around the world, including from the Institute for Healthcare Improvement and the Clinton Health Access Initiative, as well as through site visits to The Ihangane Project, the MESH QI and All Babies Count initiatives at Partners In Health in Rwanda, Integrate Health in Togo, and others.
Based on this best practices evaluation and Mali’s national strategy for clinical quality, we are deploying a CQI program with our government partners that incorporates three best practices to drive quality of care:
1. Quality improvement teams consisting of clinicians trained to conduct root cause analysis and process mapping so as to identify opportunities for system-level quality improvements, implement solutions and measure progress; 2. Clinical mentors to provide day-to-day accompaniment of clinicians; 3. Regular, on-site continuing medical education for clinical staff.
Through these three practices, we aim to provide clinicians and staff with the toolkit they need to identify systems problems in clinical primary care provision, implement corresponding solutions, and measure their progress. Our CQI initiative is designed to build upon health care providers’ knowledge and provide them with the resources and support they need to collaboratively identify gaps in care delivery, and set out measurable, timed goals to improve those areas, with the coaching of clinical mentors.
To ensure that this approach could be scaled within the public sector, Muso staff and government health center leaders worked together closely to adapt the CQI model. Dr. Bourema Cissé, Medical Director at the government-run Yirimadio community health center, ensured that the strategies and approaches were feasible, adoptable, and have the potential for replicability across government health centers. As CQI trainer and Muso’s Urban Site Coordinator, Dr. Mariam Cissé explains, “we started CQI in partnership with the district hospital simply because we want to see replicability.” She adds, “if it’s possible for the government to implement at the Yirimadio community health center, the district hospital could replicate the model in other regional community health centers.”
To kick off this new approach, our first workshop was held at the government-run clinic in our flagship Malian direct service site, Yirimadio. This workshop trained health center clinicians and staff on foundational CQI curricula, including an introduction to CQI, problem-solving, root cause analysis, and data use for quality improvement. With these initial tools, the group then built out plans for quality improvement projects to be implemented within the Yirimadio clinic, beginning with reproductive and maternal health topics.
Clinical care providers, including Fatimata Bouré, Dr. Habib Doucara, Dr. Mariam Cissé, and Oumou Diabaté (left to right), brainstorm measurable goals to address gaps in health care delivery at the clinic level.
Supporting the design and facilitation of these improvement projects is Dr. Nantenin Diakité, Yirimadio’s new reproductive health mentor who will provide ongoing education, coaching, and accompaniment to midwives and other clinical staff. Dr. Diakité, who will monitor and support clinicians’ progress through her daily work, is optimistic that CQI will lead to measurable improvements in clinic-level outcomes. She adds that while this initiative is just beginning, it will evolve with time, and will be supported by the collective discourse and goals from the team’s first foundational workshop together.
Moving forward, the CQI initiative will expand beyond a reproductive and maternal health focus area in the Yirimadio clinic to other areas of care provision. As this work evolves in Yirimadio, Muso also plans to implement it in partnership with the government clinics in our eight rural sites later this year, and we remain committed to measuring our progress across geographies. As Dr. Hannah Jones, a Muso-based HEAL Initiative Fellow who assisted with the rollout of the CQI initiative explains, “We are all learning together about how to… enact and analyze changes to the current system… I’m hopeful that it will catch on and that we’ll start to see an impact. And, if so, it will be a great example for other [clinics].” As Mali’s government rolls out a national health system reform over the next four years, including commitments to invest in clinical care, Muso will continue to build evidence-based best practices to serve as a scalable model, both within Mali and globally.