ISQUA17-3268REMOTE FACILITATION OF QUALITY IMPROVEMENT PLANS USING WHATSAPP MOBILE APPLICATION IN KWARA STATE, NIGERIA

Abstract

Objectives: Kwara State is located in the North-Central zone of Nigeria. It is predominantly rural with an estimated population of 2.6 million persons (National Bureau of Statistics). In 2015, a quality improvement initiative commenced in health facilities implementing the Saving Lives @ Birth program which is aimed at improving maternal and child health outcomes. Baseline assessments were conducted in ten facilities using SafeCare Essentials tool and tailored quality improvement plans (QIP) were developed for each facility. Monthly facilitation visits were conducted to mentor facility quality teams on the implementation of activities in the quality improvement plans. However, distance and poor road network were limiting factors for routine monthly visits for QIP facilitation. A remote facilitation pilot using mobile technology was launched in August 2016. A study was also conducted to investigate the cost-effectiveness of this mode of facilitation, benefits and challenges. Method(s): Mobile internet penetration in Kwara was 66% in the first quarter of 2016 according to the National Bureau of Statistics and all facility quality leads had access to internet-enabled phones. With its extensive global penetration including Kwara and ease of use, WhatsApp mobile application was the technology of choice for the remote facilitation pilot in ten health facilities (four private and six public). A generic quality improvement plan was developed for participating facilities. SafeCare Quality Managers moderated remote facilitation group sessions for 1 hour weekly. During sessions, facility quality managers were mentored on one or more activities in the generic quality improvement plan. Evidence of activities implemented were posted as pictures or documents on the group forum or shared via email. New QIP activities to be implemented were assigned at the end of each session. A log was also maintained by each facility and the moderator to track completion of QIP activities. Result(s): The average time spent during on-site facilitation visits was estimated as 2.5 hours monthly and WhatsApp facilitation 4 hours monthly. 1. Efficiency improved in terms of manpower hours and fuel consumption. Over a six-month period, manpower hours lost commuting was estimated as 207 man hours. Comparing the time spent on facilitation of ten facilities; the average time for remote facilitation was 4 hours monthly while on-site facilitation was estimated as 150 man hours, thus saving additional 146 man hours. Using a fuel consumption rate of 7.1litres/ 100 km for a Toyota Hilux, cost of fuel over a six-month period was estimated at 325 Euros. However, six-months internet data plan for the moderator cost 8 Euros only. 2. WhatsApp platform fostered cross learning and replication of best practices in quality improvement among health facilities. 3. Group sessions promoted competition between facility quality managers on completing QIP activities and better relations. 4. Relatively high quality scores at follow-up assessments ranging from 43% to 71%. Conclusion(s): Remote facilitation using WhatsApp is a cost-effective facilitation tool to mentor facility quality teams on implementing QIP activities. Participating facilities had good results at follow-up assessments with quality scores ranging from 43% to 71%. Overall, remote facilitation through WhatsApp fostered peer to peer learning, replication of best practices, competition and better interactions among facility quality managers.