by Whitney Isenhower
February 3, 2011
The Global Health Workforce Alliance recognized a URC human resources project that has reduced maternal mortality in 15 hospitals and health centers in Niger. The Alliance, a World Health Organization-affiliate, honored the Niger Human Resources Improvement Collaborative directors and its key implementer, Dr. Saidou Ekoye, at the Second Global Forum on Human Resources for Health. The Collaborative was among 36 human resources success stories and Dr. Ekoye one of 12 health workers honored at the January 25-29 Forum in Bangkok, Thailand. The Collaborative, implemented in Niger’s Tahoua region, is part of the USAID Health Care Improvement (HCI) Project’s work to ensure quality patient care in more than 25 low- and middle-income countries worldwide. URC manages the HCI Project at its headquarters in Bethesda, Md.
The Alliance honored both Dr. Ekoye and Dr. Maina Boucar, URC’s West Africa Director, for their achievements in using human resources to increase health worker efficiency that ultimately improves Niger’s maternal and child care.
“I was really surprised because we were just at the first steps in our performance cycle,” said Dr. Boucar. “I think it’s an honor really for Niger, our team and the field staff to be recognized for their work.” Dr. Boucar is a physician based in Niamey, Niger who has worked with numerous health care, as well as maternal and child health programs for more than a decade. He has overseen the human resources project since its April 2009 launch in collaboration with the Ministry of Public Health.
During the Forum, Dr. Ekoye presented the Collaborative’s accomplishments in reducing maternal and child deaths, a Niger primary health objective. More than half of maternal deaths worldwide occur in sub-Saharan Africa,1 with "640 maternal deaths per 100,000 live births."2 Dr. Ekoye, who became the Ministry of Health’s General Secretary in November 2009 after working with URC, said Niger’s need for interventions was instrumental in executing the project.
“This led us, surely, to create and set up a network of quality improvement teams,” he said.
Since the Niger Collaborative’s implementation, its 15 facility and 11 management health worker teams have seen vast improvements in the workers’ effectiveness and patient care throughout eight districts. Sites meeting the country’s requirement of ensuring skilled attendants are present at births increased from 12.5% (one out of eight districts) to 75% (six out of eight districts). All 303 health workers now have written job descriptions that aid in clarifying and assigning tasks, and patient waiting times have decreased from more than two hours to sometimes five minutes in implementing sites. Improving worker efficiency ensures doctors, nurses and midwives understand and can effectively perform their tasks in providing patient care and overseeing safe and healthy childbirths.
An improvement collaborative approach brings together workers from all health-system levels—central, regional, hospital, health center and sometimes community—to outline objectives, roles and tasks that aid productivity and provide better care. Forming quality improvement teams that regularly meet to discuss successes and challenges is key to implementing this work. An HCI Project December 2009 report demonstrated this approach’s effectiveness in positively affecting health outcomes in 12 countries worldwide.
Dr. Boucar said the Niger Collaborative’s objective of creating written jobs descriptions for health workers has been its biggest achievement thus far.
“This made (health workers) comfortable, saved time, focused on key activities and they produce more,” he said.
The Collaborative will be carried out through the end of 2011, and the process developed in Tahoua is now part of the Ministry’s 2011-2015 national action plan to improve health in the country. The Ministry is also adapting the approach to improve organization in two of its departments: human resources and maternal child health.
Dr. Ekoye said he hopes to eventually involve other partners in the Collaborative, and its successes on the ground are vital to ensuring them at a national scale.
“If the work is not done at the district level,” he said, “we cannot do it at the central level.”
1World Health Organization online. 2010. “Maternal mortality: Fact sheet N°348, November 2010.” http://www.who.int/mediacentre/factsheets/fs348/en/index.html.
2Childinfo, Monitoring the Situation of Children and Women online. UNICEF. 2010. “A global overview of maternal mortality, Substantial geographic disparities in maternal mortality.” http://www.childinfo.org/maternal_mortality.html.