Table 1 Quality improvement interventions, fidelity dimensions and measurement indicators with data sources

Content

PRCMM: comprises of the following set of activities

1. Compiling past 6 months data from iCCM registers of HPs

2. Completing quality grids for every HPs

3. Identifying and prioritizing major problems of service quality

4. Performing root cause analysis on identified problems

5. Providing clinical mentorships to HEWs (by trained mentors) based on charts

6. Presenting key findings of iCCM to participants

7. Evaluating HPs iCCM performance in the larger group

8. Providing mentoring to HEWs in nearby health centers

9. Developing action plan

Indicator: The proportion of PRCMM contents implemented during the sessions (content adherence)

Data source: PRCMM observations

Supportive supervision: comprises of the following set of activities

1. Discussing on the diagnosis and treatment of childhood illnesses

2. Observing record keeping

3. Check register for completeness and consistency

4. Check availability of iCCM medicines and supplies

5. Observe client consultation with HEWs

6. Provide feedback

Indicator: Supportive supervision contents addressed during supervisory visits (content adherence)

Data sources: Interview with HEWs, Record review (supportive supervision checklists)

Frequency

PRCMM: Expected to be conducted bi-annually (every 6 months) per district

Indicator: Average number of PRCMMs conducted during the 12-month survey period

Data source: Interview with District staff, PRCMM reports

Supportive supervision: Expected to be conducted every 3 months

Indicator: Average number of supportive supervisions conducted with an iCCM focus during the 12-month survey period

Data source: Interview with HEWs, Supervision reports

Medicines supply: Expected to be supplied monthly based on the needs of HPs

Indicator: Average number of iCCM medication deliveries during the 12-month survey period

Data source: Interview with HEWs, Drug ledgers

Duration

PRCMM: One session expected to be conducted for two days

Indicator: Average number of days PRCMMs are conducted

Supportive supervision: Not applicable

Not applicable

Medicines supply: Not applicable

Not applicable

Coverage

PRCMM: such sessions are expected to reach all HEWs in the district bi-annually

Indicator: Percentage of HEWs reached with bi-annual PRCMM during the 12-month survey period

Data source: Interview with HEWs, PRCMM reports

Supportive supervision: expected to reach all HEWs and HPs in the district quarterly

Indicator: Percentage of HEWs who received quarterly supportive supervisions with an iCCM focus during the 12-month survey period

Data source: Interview with HEWs, Supervision reports

Indicator: Percentage of health posts covered with quarterly supportive supervisions with an iCCM focus during the 12-month survey period

Data source: Interview with HEWs, Supervision reports

Medicines and job aids supply: medicines are expected to be supplied to all HPs monthly, and the job aids are supplied once

Indicator: Percentage of health posts supplied monthly with iCCM medicines during the 12-month survey period

Data source: Interview with HEWs, Drug ledgers

Indicator: Percentage of health posts supplied with iCCM register and chart booklets during the 12-month survey period

Data source: Interview with HEWs