Evaluation of a Quality Improvement (QI) Intervention for Maternal, Newborn, and Child Health (MNCH) in Colombia: The Mil Días Intervention of SINERGIAS in the Department of Bolívar

Abstract

Initiated in 2012, the Mejoramiento de la calidad de la atención a gestantes, niñas y niños en sus primeros mil días (Mil Días) intervention is a strategy for quality improvement (QI) of maternal, child, and newborn health (MNCH) across 6 departments of Colombia. In the department of Bolívar, Mil Días is implemented in 25 health facilities across 12 municipalities. A time series analysis was conducted to determine whether or not contextual factors affect the rate of QI of antenatal care (ANC) among health facilities in Bolívar targeted by the Mil Días intervention. Multivariate linear regression analysis was used to examine relationships between predictors of interest and ANC performance over time. Important covariates included type of health facility (private or public), municipality level percentage of households with unsatisfied basic needs, number of health facilities per 100,000 municipal inhabitants, and MNCH patient volume per health facility. Findings were that quality of ANC, as measured by mean ANC performance scores or average rates of ANC indicators, increased over the implementation of Mil Días. Multivariate linear regression modeling demonstrated that health facility type was a significant predictor of the rate of QI of ANC, with public facilities showing an increased rate of QI as compared to private health facilities. This evaluation of Mil Días provides evidence of the importance of contextual influence on QI intervention results. Future studies examining program context ought to be conducted to inform QI strategies for the implementation of MNCH and related health services.