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

What is it about?

This study evaluates the real-world effectiveness of Diagnose-Intervene-Verify-Adjust (DIVA), an innovative quality improvement mode, in improving PHC bottlenecks impeding health system performance in Kaduna, a Northern Nigerian state. DIVA is a 4-step quality improvement model designed for district health systems. ‘Diagnose’ identifies constraints to effective coverage of interventions; ‘Intervene’ develops/implements action plans addressing constraints; while ‘Verify/Adjust’ monitor performance and revise plans. An embedded a mixed method study design involving participant observation was employed between 2013 and 2016. 183 bottlenecks were identified by LG teams across all interventions in 2013. 41% of bottlenecks concern human resource availability. Geographical access and availability of commodities ranked least. Availability of commodities was the most improved determinant after 3 years, albeit among the least constrained. 562 activities were planned to address identified bottlenecks in the state, of which only 568 (36%) were completely implemented This study demonstrates that PHC planning using the DIVA model can potentially improve health system performance. However, effective implementation is critical.

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