Abstract
This summary presents the objectives, findings, lessons learned, and recommendations of the fall 1998 evaluation of a quality assurance (QA) program in Niger, a French-speaking country in West Africa with a population of 10 million. The Nigerien QA Project (QAP) began in the Tahoua region in 1993 and in 1997 merged with another health care program -- Basic Support for Institutionalizing Child Survival (BASICS)-- to become the joint QAP/BASICS project. Later, the Konni District (Tahoua) and the Boboye District (Dosso) were selected for QAP/IMCI (Integrated Management of Childhood Illness) interventions; this was the first time in the history of international health interventions that IMCI was introduced in an environment where QA practices were in place. Important lessons learned from the evaluation of the first 5 years of Nigerien QAP and QAP/BASICS relate to the savings and benefits derived from introducing IMCI in a QA environment, the ability of health care providers to learn and adapt QA principles and implement solutions, the development of teamwork among QA-trained staff, and the importance of coaching and meetings to support and sustain QA activities. The story of QA in Tahoua stands out as an excellent example of how QA activities can improve the quality of care, even in the face of severe resource constraints. (Author abstract)