Health Care Intervention Research- Improving Pre-natal and Maternal Care (QUALMAT)

Besides a dramatic lack of financial and human resources in developing countries, health care is additionally endangered by quality deficiencies caused by low staff motivation. This lack of motivation leads to an insufficient translation of knowledge into optimal utilization of resources. The "know-do" gap represents a challenge that must be addressed to strengthen health services performance towards achieving the Millennium Development Goals (MDGs). This is in particular true for some sensitive sectors like pre-natal and maternal health care. General objective of this research is to improve maternal health through better pre-natal and maternal care services offered by better motivated health workers. A computer-assisted clinical decision support system (CDSS) will be developed, implemented and tested aiming at (I) quality improvement of maternal and newborn care and (II) assessment of provider's performance. Based on this tool a commonly agreed incentive scheme to increase motivation will be shaped and tested in three SSA - countries, namely Burkina, Ghana, and Tanzania.

The incentive scheme might contain both non-monetary and monetary incentives and will be designed according to the human resource policy in the three countries. The planned approach is an implementation study with control arms containing one hospital and 6 first line health facilities in each of the study districts and an equal number of facilities in the control arm. A set of indicators for measurement of changes in quality of delivered services will be identified in order to follow up the sustainability and effectiveness of the strategies after their implementation. The study findings will allow understanding the important factors of staff motivation and facilitate adequate management for improvement of maternal and neonatal health care. "Knowing is not enough, we must apply; Wanting to do, is not enough, we must do it1"

- J.W. v. Goethe

• No Intervention: without CDSS
  This arm includes 6 health facilities in each partner country, where the clinical decision support system will not be implemented
  Intervention: Other: CDSS
• Experimental: with CDSS
  This arm includes 6 health facilities in each partner country, where the clinical decision support system will be implemented, parallel to the performance based incentive package
  Intervention: Other: CDSS

Inclusion Criteria:

• the patient in the primary health care center

Exclusion Criteria:

• patients outside the research regions

• Ghent University, International Center for Reproductive Health, Belgium
• Centre de Recherche en Sante de Nouna, Burkina Faso
• Navrongo Health Research Centre, Ghana
• Karolinska Institutet
• Muhimbili University of Health and Allied Sciences