title: The use of continuous surveys to generate and continuously report high quality timely maternal and newborn health data at the district level in Tanzania and Uganda.
abstract: BACKGROUND
  The lack of high quality timely data for evidence-informed decision making at the district level presents a challenge to improving maternal and newborn survival in low income settings. To address this problem, the EQUIP project (Expanded Quality Management using Information Power) implemented a continuous household and health facility survey for continuous feedback of data in two districts each in Tanzania and Uganda as part of a quality improvement innovation for mothers and newborns.
  
  
  METHODS
  Within EQUIP, continuous survey data were used for quality improvement (intervention districts) and for effect evaluation (intervention and comparison districts). Over 30 months of intervention (November 2011 to April 2014), EQUIP conducted continuous cross-sectional household and health facility surveys using 24 independent probability samples of household clusters to represent each district each month, and repeat censuses of all government health facilities. Using repeat samples in this way allowed data to be aggregated at six four-monthly intervals to track progress over time for evaluation, and for continuous feedback to quality improvement teams in intervention districts.In both countries, one continuous survey team of eight people was employed to complete approximately 7,200 household and 200 facility interviews in year one. Data were collected using personal digital assistants. After every four months, routine tabulations of indicators were produced and synthesized to report cards for use by the quality improvement teams.
  
  
  RESULTS
  The first 12 months were implemented as planned. Completion of household interviews was 96% in Tanzania and 91% in Uganda. Indicators across the continuum of care were tabulated every four months, results discussed by quality improvement teams, and report cards generated to support their work.
  
  
  CONCLUSIONS
  The EQUIP continuous surveys were feasible to implement as a method to continuously generate and report on demand and supply side indicators for maternal and newborn health; they have potential to be expanded to include other health topics. Documenting the design and implementation of a continuous data collection and feedback mechanism for prospective description, quality improvement, and evaluation in a low-income setting potentially represents a new paradigm that places equal weight on data systems for course correction, as well as evaluation.
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, UK. Tanya.Marchant@lshtm.ac.uk.
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.forename: Claudia
authors.initials: C
authors.lastname: Hanson
authors.forename: Silas
authors.initials: S
authors.lastname: Temu
authors.forename: Kajjo
authors.initials: K
authors.lastname: Darious
authors.forename: Yovitha
authors.initials: Y
authors.lastname: Sedekia
authors.forename: Joseph
authors.initials: J
authors.lastname: Akuze
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Rowe
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D007229:Infant Welfare / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D007407:Interviews as Topic; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D011247:Pregnancy; D058996:Quality Improvement; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology