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Q.A. REPORTS. 1993 Jun; 1-2.In May, 1992, the Regional Directorate of Health (DOH) in Tahoua, Niger, launched efforts to strengthen primary health care services in the region. The DOH organized a workshop for regional leaders to articulate their own vision of high quality health services for the regional health care system. Additionally, managers began applying fundamental quality assurance (QA) concepts and techniques to rectify service deficiencies. Tahoua's regional director and the QAP resident advisor invited technical and administrative directors of regional services and the district medical officers to participate in a workshop to win support for QA. The health managers first examined their individual values, the Tahoua regional health care organization's values, and community values. After viewing videotaped interviews documenting Nigerians' level of satisfaction with health care services, workshop participants recognized that clients have unique perspectives on favorable health care. Hence, the providers included responsiveness to client needs as a key factor in their vision of high quality care. The participants developed possible answers to the three key questions influencing a mission statements: 1) what services are provided; 2) for whom are they provided; and 3) in what fashion are they provided. The responses from all participants resulted in a regional mission statement. Trainers presented QAP's approach to quality improvement: 1) planning for quality assurance; 3) problem solving to correct deficiencies. Workshop participants immediately applied QAP quality improvement concepts by practicing with case studies and by examining actual health system problems. Participants will continue working in teams to devise and test solutions to selected problems. QAP's resident advisor will provide the teams with intensive coaching for effective application of quality improvement methodology. By the end of its two years of technical support, QAP intends to leave a core group of health personnel operating at all levels of Tahoua's primary health care system.
Q.A. REPORTS. 1993 Jun; 1-2.The Quality Assurance Project (GAP) has collaborated with CARE-Guatemala to carry out a unique application of quality assurance methods to public health promotion. CARE asked GAP to analyze the problem of inadequate latrine use among those rural communities served the CARE's water and sanitation project. GAP used a quality design techniques known as quality function deployment (QFD), which originated in Japanese industry, and considers client preferences at the product design stage. The method users matrices to compare products and to explore the relationships between a product's technical components and the user's needs and preferences. In September, 1992, GAP led a workshop for CARE and Ministry of Health staff showing the application of a simplified QFD approach by a flow chart. The group listed five priority quality characteristics for the optimal latrine: easy to clean, safe for children, allows for corn cob use, not scary to sit on, and does not smell bad. Then competing products were consideration; the latrine, the open field, and the flush latrine. Measurements were used to score each products: 1) the rate of improvement required; 2) determination of the key features for latrine promotion; and 3) the calculation of absolute and demanded quality weight. During the workshop, a water and sanitation expert presented an overview of various latrine designs from around the world and their respective worth and disadvantages. A spirited discussion made it clear that insufficient health education promoting the use of latrines was not the only factor that contributed to low utilization rates. Areas of high correlation indicated a priority area for redesign. The chart revealed a strong relationship between the toilet seat and children's safety. Guatemalan Ministry officials and USAID are considering future use of QFD in their latrine design efforts. This exercise helped them to explore user attitudes and their implications for technical design.