ArticleBMJ open2019
Effectiveness of the Diagnose-Intervene- Verify-Adjust (DIVA) model for integrated primary healthcare planning and performance improvement: an embedded mixed methods evaluation in Kaduna state, Nigeria.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 25 citations in OpenAlex.
- Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial.BMJ global health · 2021Trial
- Barriers and bottlenecks to implementation of WHO recommendations for prevention, detection, and treatment of postpartum hemorrhage: a mixed-methods triangulation study.Implementation science communications · 2026Article
- Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review.PLOS global public health · 2024Article
- A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol.Implementation science communications · 2023Article
- Shared Care Practices in Community Addiction and Mental Health Services: A Qualitative Study on the Experiences and Perspectives of Stakeholders.Healthcare (Basel, Switzerland) · 2022Article
- Clinical guidelines for managing hearing loss as a complication of drug-resistant tuberculosis treatment: an evaluation of implementation fidelity in Kano, Nigeria.BMC health services research · 2022Article
- Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria.The Pan African medical journal · 2022Article
- Bridging the 'two communities': how an emerging primary healthcare global research consortium can help achieve universal health coverage in low and middle-income countries.BMJ global health · 2019Article
- Maternal Self-rated Capability Status and Its Association with Under-Five Children Morbidity.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 4 countries.
Funding
Abstract
objectivesThis study evaluates the real-world effectiveness of Diagnose-Intervene-Verify-Adjust (DIVA), an innovative quality improvement mode, in improving primary healthcare (PHC) bottlenecks impeding health system performance in Kaduna, a northern Nigerian state.
designAn embedded mixed method study design involving participant observation.
settingPHCs in 23 local government areas of Kaduna state, Nigeria.
participants138 PHC managers across the state (PHC directors and programme managers in the 23 local governments).
interventionDIVA is a four-step improvement model in which 'Diagnose' identifies constraints to effective coverage, 'Intervene' develops/implements action plans addressing constraints, while 'Verify/Adjust' monitor performance and revise plans. PRIMARY AND SECONDARY OUTCOME MEASURES: The model, as adapted in Nigeria, is designed to evaluate and improve the availability of health commodities, human resources, geographical accessibility, acceptability, continuous utilisation and quality of four PHC interventions (immunisation, integrated management of childhood illnesses, antenatal care and skilled birth attendance).
results183 bottlenecks were identified by local government teams across all interventions in 2013. 41% of bottlenecks concern human resources. Geographical access and availability of commodities ranked least. Availability of commodities was the most improved determinant although among the least constrained, probably indicating skewed implementation of operational plans. 1562 activities were planned to address identified bottlenecks in the state, of which only 568 (36%) were completely implemented
conclusionOur study demonstrates that PHC planning using the DIVA model can potentially improve health system performance. However, effective implementation is critical and may require some central government oversight.
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