Quality Improvement

The NURHI 2 quality improvement strategy is an evidence-based, process-improvement approach aimed at identifying and bridging gaps by comparing standards with current realities. This strategy fosters client satisfaction and expands access to high-quality health care services. The NURHI 2 quality improvement strategy comprises five phases: define, measure, analyse, improve and control. This approach influences changes in six elemental areas, as outlined by the Bruce/Jain framework; namely, the choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and appropriate constellation of services. These six elemental areas together constitute the foundation for defining the goals and evaluating the outcomes of the NURHI 2 quality improvement strategy. The three elements that determine quality improvement in family planning service delivery performance include the following:

• Service Delivery Environment

• Capacity Building Sessions

• Tools

Quality Improvement

Service Delivery Environment

  • Performance Improvement Assessment and Plans
  • Whole Site Orientation
  • Clinic Makeovers
  • Stock-out Prevention
  • Supportive Supervision

Capacity Building Sessions

  • Clinical: Intrauterine Device (IUD), Implant
  • Non-clinical: Interpersonal Communication and Counselling, Referral
  • Contraceptive Technology Update
  • Contraceptive Logistics Management System
  • Service Delivery of Social and Behavioural Change Communication Interventions (e.g. client-provider dialogue)
  • On-the-Job Training


  • My Family Planning Guide
  • Distance Learning Education
  • Counselling Guide

Phase 1 of the Nigerian Urban Reproductive Health Initiative (NURHI) contributed to an impressive 11.5% increase in modern contraceptive use among women of childbearing age over its five years of implementation (NURHI Endline Report, 2014). As a result, over 350,000 more families began using family planning methods

Selection of High-Volume Sites

In NURHI 1, a high-volume site was defined as a public or private health care facility serving the greatest number of maternal, newborn and child health clients (antenatal, delivery and immunisation clients) in the project cities. In NURHI 2, high-volume sites include only public health facilities.

Expanded Equity Access to FP Services

Expanding access in NURHI 2 focuses on using proven and new strategies to improve access to a wide range of modern contraceptive methods. The ultimate goal is to reach every woman in need to provide high-quality family planning services and a wide range of modern contraceptive options.

Tackling Provider Bias

Empirical evidence from a NURHI 2 facility baseline study showed that providers have beliefs and perceptions that prompt them to restrict access to family planning services based on the client’s age, marital status, parity and partner’s consent.

72-Hour Clinic Makeover

The NURHI 2 72-hour clinic makeover concept is one of its novel service delivery approaches. The environment in which family planning services are provided makes a difference in improving health care delivery for both the service provider and clients.

Service Delivery Job Aids

The Community Health Extension Workers booklet is a logbook that states the essential skills to be learned by these providers, including the required number of simulation and real-life experiences. It also provides space for the instructor to add a performance score and sign off when the learning exercise has been completed.

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