Ciheb Nigeria Toolkit

The guide is informed by UMB’s and Ciheb’s collective CQI implementation experience over a nearly 15 year period across six low-resource countries and has been adapted to the Nigeria context. Stakeholder engagement has been emphasized throughout the application of our CQI approach to ensure buy-in to the assessment, implementation process, monitoring of CQI initiatives, and sustainability for maintenance.

Below, we share evidence-based resources developed to support the implementation of quality improvement projects. Included in the materials are valuable external resources that our teams have utilized for successful implementation of CQI. We also recommend the Aurum Institute's How to Guide for Quality Improvement, which is an easy-to-read guide and provides examples and methods for administering quality improvement.

Step 1: Conducting a rapid assessment of the facility through review of data and process mapping

Activity 1: Engage leadership within an organization for support and buy-in.
Tools: Partner Quality Assessment Tool, CQI Introduction, Quality Management Plan, Nigeria Annual CQI Calendar

Activity 2: Conduct joint rapid assessment of services and review the findings.
Tools:Facility Baseline Assessment Tool, Clinical Component Assessment Workbook

Activity 3: Developing CQI skills for the team.
Tools: CQI Curriculum 

Step 2: Capacity Building Tools

Activity 4: Conduct capacity building of CQI teams to implement CQI.
Tools: CQI Curriculum, NigeriaQual TB Software User Manual

Step 3: Identification of the opportunity for improvement

Activity 5: Identify a CQI team to drive CQI and planning processes.
Tools: CQI Team Roles and Responsibilities, CQI Committee Minutes Template, STOC Report Template, STOC Follow Up Sheet

Activity 6: Conduct a root cause analysis to identify the problem (e.g. fishbone diagram and five whys). 
Tools: Fishbone Diagram

Step 3: Planning and prioritizing

Activity 7: Use priority methodology, e.g., CQI prioritization matrix.
Tools: Problem Prioritization Matrix

Activity 8: Prioritize interventions depending on gap and other contextual factors to determine the change package.
Tools: Documentation Audit Form ART, Documentation audit form Child and Maternal FU, Documentation Audit Form Delivery, Documentation audit form General ANC and PMTCT HCT regular, Documentation Audit Form HCT

Activity 9: Use data to identify gaps in service delivery.
Tools: NigeriaQual Adult QoC Tool, NigeriaQual Financial Management QoC Tool, NigeriaQual Logistics QoC Tool, NigeriaQual Pediatric QoC Tool, NigeriaQual PMTCT QoC Tool, NigeriaQual Program Management QoC Tool

Step 4: Data interrogation for data gaps and corrective measures

Activity 10: Interrogation of data for identification of gaps in implementation.
Tools: HCW Satisfaction Survey Form, Patient Satisfaction Survey, HRH Situation Analysis Form

Activity 11: Stepwise approaches for bridging implementation gaps.
Tools: QoC Tool Presentation Format, Health Systems Situation Analysis Form