Lessons learned from approaches to improve the case management of sick children in a quality assurance environment in Niger

Qualitative as well as quantitative information was collected to show how the combination of general quality assurance principles with systematic monitoring of technical and managerial competence leads to better program outcomes. Based on these lessons learned are recommendations for routine monitoring through supervision using a checklist with valid and reliable indicators. Immediate problem solving at the facility level is the primary purpose of the checklist, but the information is also useful for district health teams to monitor service quality and to conduct participatory reviews and activity planning. While Niger faces very special environmental and structural challenges, it also shares many problems and solutions with other countries in Africa that try to improve service quality and access. The capacity built in Niger could serve as a regional training site to train health managers and trainers from other countries in quality assurance techniques and in the adaptation and use of tools including supervision checklists and surveys. (Author abstract)