Table 1.
Activity | Purpose | Source and method | Measures |
---|---|---|---|
Assessment of immunization doses | • Establish baseline and monitor trends associated with system improvements | • Usual administrative data reported from the HUs to the District and from the District to UNEPIa | • Number of DPT1 and DPT3 dosesb: DPT1 static, DPT1 outreach, DPT3 static, DPT3 outreach |
Initial assessment at HUs (June 2011) | • Develop improvement teams • Gain in-depth understanding of each HU’s context related to RI |
• Caregiver focus groups • 5 Ps—purpose, mapping hard to reach people, personnel, process flow charts, patterns • Introduce HUs to meeting skills |
• Microsystem components • Barriers and enablers to RI |
4 Participatory workshops (attended by five HU and one district QI team: June 2011, September 2011, December 2011, February 2012) |
• Problem identification • Improvement plan development • Implementation of improvement plan • Reflection on improvement process • Transition to local ownership |
• Pre-workshop participant information survey • Before and after action reviews • Observation • Workshop evaluation |
• Specific workshop objectives • Pre-intervention baseline: QI knowledge and work environment • Interest and acceptance of Microsystems Approach • Knowledge, skills, and abilities related to Microsystem Approach • RI knowledge • Barriers/enablers to RI • Team and collaboration skills • Ability to work across systems |
QI team coaching (June 2011–February 2012 between workshops) |
• Support progression of QI teams’ improvement work • Foster linkages between the district and HU staff and community |
• PDSA tracking matrix • Run charts • Attendance roster • Meeting minutes • Coach’s reflective journal • Technical assistance from coach |
• Implementation of improvement plans • Consistency of team participation in meetings • Emerging leadership • Group function • Meeting skills • Coach’s role development |
Evaluation by researchers external to projectc (February 2012) | • Validation of findings | • Focus groups • Survey |
• In-person meetings of all workshop participants using structured interview guide • Written questionnaire completed individually by workshop participants |
aRI data were provided to us by the District Health Inspector.
bRI data were collected and recorded in the usual way by the HUs throughout the intervention period and were transposed in an Excel spreadsheet by the District Health Inspector and the Coach.
cData were collected by Ugandan researchers, guided and analyzed by Center for Program Design and Evaluation at Dartmouth College.