How quality assurance facilitates decentralization in a primary health care system: the case of Niger.

Nigers Quality Assurance Project has improved the delivery of primary health care services and facilitated the implementation of decentralization. In the Tahoua region a multidisciplinary Quality Improvement Team has addressed the problem of child malnutrition by arranging for children to be assessed and treated in the same day by a team of providers. As a result of this intervention child dropout rates at the health center dropped from 40% to 20% the nutritional rehabilitation rate rose from 7% to 34% average counseling time increased from one to five minutes and the average waiting time was reduced from four hours to 40 minutes. Collaboration between the Tahoua departmental and district health services and the Quality Assurance Project has strengthened the analytical skills and action-oriented decision-making capabilities of district-level staff. On the basis of the Tahoua regions successful experience the Government of Niger is considering the integration of quality assurance measures into broader health sector reform.