Effectiveness of healthcare providers’ performance improvement interventions for childhood acute respiratory infection management in Sub-Saharan Africa

This study evaluated the effectiveness of interventions for healthcare provider’s performance (HCPP) improvement with a focus on childhood acute respiratory infections (ARIs) management in Sub-Saharan Africa. Using a systematic and statistically supported analysis of literature, the eligible study designs were randomised and non-randomised studies with pre-post-test comparison, and outcomes of percentage and continuous measures of HCPP. The effect size was estimated using ‘difference in difference’ and summarised as ‘median effect size’. Strategy implementation and context were evaluated using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model. Twenty-one studies implemented 17 HCPP improvement strategies. Among the hospital-based healthcare providers (HCPs), ‘training, supervision and mhealth’ showed the largest effect (68.9%) whereas for community-based HCPs (CHWs), ‘training, supervision, strengthening infrastructure, and HCP-directed financial incentives’ had the largest effect (60.05%). Strategies incorporating HCP-directed financial incentives were likely to have very large effect (60.0% and 51.2%). Only supervision (17.0%) and mhealth (–5.0%) were tested as standalone strategy and had high quality of evidence. Effectiveness of strategies for HCPP improvement varied in this study, however, it appears that multifaceted strategies could be more effective than standalone strategies.