Standards-Based Management and Recognition for Child Health: A Synthesis of Initial Experiences in Guinea and Zimbabwe

The Maternal and Child Survival Program (MCSP) Child Health Team sought to learn from the process, challenges, and lessons learned in applying the Standards-Based Management and Recognition (SBM-R) approach in two countries, Zimbabwe and Guinea. In Guinea, MCHIP tested the use of SBM-R for six months in three urban health centers—Dabola, Mandiana, and Diakolidou—to improve health worker adherence to technical guidance for high-impact interventions. The core process of SBM-R consists of setting performance standards, implementing those standards, measuring progress, and rewarding achievements. Implementation of SBM-R is built around three training modules, and like other quality improvement approaches, uses the cyclical process with a distinct step of "recognition" of individuals or facilities for improved performance upon correct completion of the process. The SBM-R approach has been implemented in 16 MCHIP-supported countries in various technical areas, including maternal health, newborn health, infection prevention, HIV, and malaria. In Guinea, the approach was tested to improve the quality of case management for childhood illness. The results of the initial experience in Guinea showed that health worker adherence to technical guidance improved significantly, with a notable increase in the use of correct treatment protocols for childhood illnesses. In Zimbabwe, MCHIP also piloted the use of the SBM-R approach to improve the quality of case management for childhood illness. The approach was implemented in three rural health centers—Murewa, Chivhu, and Gwanda—to improve health worker adherence to technical guidance for high-impact interventions. The results of the initial experience in Zimbabwe showed that health worker adherence to technical guidance improved significantly, with a notable increase in the use of correct treatment protocols for childhood illnesses. The findings from Guinea and Zimbabwe highlighted the importance of building capacity for implementation and leadership, technical capacity to implement SBM-R, health worker training, monitoring and recognizing performance, and cost analysis. The results also emphasized the need for a cyclical process involving measuring a performance gap, understanding the causes of the gap, followed by testing, planning, and implementing interventions to close the gap. Key messages from the synthesis of initial experiences in Guinea and Zimbabwe include the importance of using a cyclical process for quality improvement, the need for building capacity for implementation and leadership, and the importance of monitoring and recognizing performance. Recommendations for quality improvement and performance improvement approaches include the use of SBM-R, the importance of building capacity for implementation and leadership, and the need for monitoring and recognizing performance. The synthesis of initial experiences in Guinea and Zimbabwe provides valuable lessons learned for the application of SBM-R to child health, including adaptation in countries where it is the preferred approach in other health service areas. The findings from this synthesis will inform a process of developing an approach to improving child health services that is responsive to the unique needs of this technical area, which can be adapted and implemented in MCSP-supported countries.