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The Impact of a Quality Improvement Package on the Quality of Reproductive Health Services Delivered by Private Providers in Uganda

This report seeks to determine whether a Quality Improvement (QI) package designed to enable small-scale commercial reproductive health (RH) service providers to improve the quality of services provided through self-assessment, action-planning, and supervisors' support is effective in improving service quality. The study was conducted among private midwives who are members of the Uganda Private Midwives Association (UPMA). A pre-test post-test quasi-experimental panel study design was used to assess the impact of the QI package developed by Private Sector Partnerships-One (PSP-One). Midwife clinics were allocated to two experimental groups and one control group. Baseline and follow-up measurements on structural attributes of quality were taken at midwife clinics using a facility inventory and midwife interview. Baseline and follow-up measurements on process attributes of quality, including the quality of counseling and the technical aspects of family planning (FP), antenatal care, and postnatal care services, were taken during service delivery through observations of client-provider interactions. A fixed effects estimator was used with a difference-in-differences model on data from the panel of midwives. Data on client observations were treated as cross-sectional and a Huber-White sandwich estimator was used to provide robust standard errors using a difference-in-differences model.