Seven years ago, IHI launched a flagship project — Project Fives Alive! — together with local partners in support of Ghana’s efforts to save the lives of children.
The five-year quality improvement initiative was linked to remarkable results: across seven regions of Ghana, 140 hospitals saw an average 34 percent decrease in deaths of children under 5 years old after the improvement program was scaled up.
Last month, the leaders of that project marked another significant milestone in the rapid emergence of quality improvement (QI) in Africa, with the foundation of the Ubora Institute — Africa’s first institute dedicated to the use of improvement science to achieve the best in health and health care for the people of Africa. Ubora, which means “excellence” in Swahili, has already lined up work in partnership with IHI to support health systems in Ghana and Liberia.
I asked Pierre Barker, Senior Vice President at IHI and Ubora Institute board member, a few questions about the new organization and how IHI is supporting it.
Before IHI launched Project Fives Alive!, was there a history of health care quality improvement in Africa?
QI came late to health care across the globe, compared to other industries. But its introduction in Africa and other low- and middle-income countries (LMIC) was especially slow — many places had not used QI as a means of improving health system performance until the early 2000s.
Working in South Africa in 2004, I saw that this approach was novel in that setting. Since then, IHI and several other organizations have been using QI in a number of LMIC countries. This method is now broadly accepted as a primary means of improving outcomes.
Undoubtedly, Project Fives Alive! has generated a lot of interest. The leaders of that work (a partnership between IHI, the Ghanaian National Catholic Health Service, and the Ghana Health Service with funding from the Bill and Melinda Gates Foundation) have worked hard to tell its story widely, using data to show improvement, using vivid descriptions of how improvement took place, and hosting delegations from other LMIC countries interested in the success of this work.
One confusing aspect of the rise of QI is that there are many variants of improvement approaches being used, and people refer to all of them as “QI.” Nevertheless, there’s a broad move away from external inspection and central planning to QI-influenced approaches such as aim setting, continuous measurement, and testing of local ideas.
A lot of global health work has focused on resource investment in health care — bringing new technologies, better facilities, and trained staff to communities that lack some of the most basic health care services. Why is this strategy insufficient to produce quality care?
There is no question that lack of resources is a major barrier to improving health care delivery in LMICs. But the Donebedian model of health care quality teaches us that improvement of the performance of health systems requires improvement of processes as well as inputs. QI is directed at improving processes. However, it is not an alternative to — or in competition with — other approaches to improving health systems. It’s a key addition.
The QI method, more than the other approaches, puts more control for improvement in the hands of managers and frontline workers, and taps into the wealth of knowledge and experience that exists in any health system. QI can work synergistically with other methods, ensuring the other much-needed investments are successfully implemented.
Why did local QI experts decide to launch Ubora, and what’s its relationship to IHI?
Some of the quality improvement experts behind Project Fives Alive!, including the director of that project, Dr. Sodzi Sodzi-Tettey, decided to set up an Africa-based institute that will secure the legacy of the Project Fives Alive! program and offer an opportunity to work in close partnership with IHI and other organizations. At IHI, we are very excited about the prospect of building strategic partners in Africa with organizations like Ubora.
IHI is dedicated to building the capability of key partners to undertake QI work in their regions of influence. Ubora’s launch comes at a very strategic time. Belief in QI is rising rapidly, and there is a move away from US-based NGOs to locally based organizations supporting the work. Supporting local partners who embody the philosophy and methods of our work is a key part of our strategy to expand our global reach.
What are some of the high-priority areas for quality improvement in health care in Africa? What does the Ubora Institute hope to tackle first?
Ubora’s highly talented team has cut its teeth on issues around maternal and child health. While Ghana and many other countries have seen much improvement in outcomes of children under 5 — in part due to the work of Project Fives Alive! — there is significant unfinished business in the realm of maternal and newborn care. Ubora’s initial work will be in maternal and newborn projects, but the skills they teach and apply are universally applicable to the rest of health care. They will be open to projects that will address some of these other health and health care issues.
Ubora undoubtedly has the best trained team of QI specialists in Africa. IHI will continue to learn much from this very talented group of improvers, and we believe Ubora is well poised for success and growth over the coming years.
You may also be interested in:
Getting Started with Quality Improvement
Lessons Learned from Ghana’s Project Fives Alive!: A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives
IHI White Paper: Improving the Reliability of Health Care
Photo credit: A maternal health Peace Corps Volunteer and her community partner in Benin. BEN 2001-016-S13 by US Peace Corps, US Government Work.