title: Building district-level capacity for continuous improvement in maternal and newborn health.
abstract: BACKGROUND
  The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care.
  
  
  METHODS
  Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes.
  
  
  RESULTS
  Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews.
  
  
  CONCLUSIONS
  MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The multifaceted approach to building capacity was critical for the success in creating lead woredas able to serve as models for other districts.
authors.forename: Kim Ethier
authors.initials: KE
authors.lastname: Stover
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
authors.forename: Aynalem Hailemichael
authors.initials: AH
authors.lastname: Frew
authors.forename: Hajira
authors.initials: H
authors.lastname: Mohammed
authors.forename: Danika
authors.initials: D
authors.lastname: Barry
authors.forename: Lamesgin
authors.initials: L
authors.lastname: Alamineh
authors.forename: Abebe
authors.initials: A
authors.lastname: Teshome
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hepburn
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Sibley
mesh_terms: D000328:Adult; D057191:Capacity Building / Q000379:methods; D003299:Cooperative Behavior; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D005002:Ethiopia; D005190:Family; D005260:Female; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D007407:Interviews as Topic; D007857:Leadership; D008427:Maternal Health Services / Q000592:standards*; D008429:Maternal Welfare; D011247:Pregnancy; D058996:Quality Improvement; D012111:Residence Characteristics; D019035:Rural Health Services / Q000592:standards; D012424:Rural Population; D055815:Young Adult
keywords: collaborative improvement; community; health systems strengthening; maternal and neonatal health; plan-do-study-act (PDSA) cycle; quality improvement