A service concept and tools to improve maternal and newborn health in Nigeria and Uganda

Abstract

Objective: The "Better Outcomes in Labor Difficulty" (BOLD) project used a service design process to design a set of tools to improve quality of care during childbirth by strengthening linkages between communities and health facilities in Nigeria andUganda. This paper describes the Passport to Safer Birth concept and the tools developed as a result.Methods: Service design methods were used to identify facilitators and barriers to quality care, and to develop human-centered solutions. The service design process had three phases: Research for Design, Concept Design, and Detail Design, undertaken in eight hospitals and catchment communities. Results:The service concept "Better Beginnings" comprises three tools. The "Pregnancy Purse" provides educational information to women throughout pregnancy. The "Birth Board" is a visual communication tool that presents the labor and childbirth process.The "Family Pass" is a set of wearable passes for the woman and her supporter to facilitate communication of care preferences. Conclusion:The Better Beginnings service concept and tools form the basis for the promotion of access to information and knowledge acquisition, and could improve communication between the healthcare provider, the woman, and her family during childbirth. K E Y W O R D SCo-design; Maternal health; Newborn health; Nigeria; Quality of care; Service concept; Service design; Uganda | INTRODUCTIONGood quality maternity care is a multidimensional concept that includes timely, effective, and appropriate use of clinical and nonclinical interventions that are sensitive to women's values and preferences. 1 To achieve improved quality of care, efforts are needed to address both facility-and community-based factors, including perceptions of quality, decision-making processes, and demand for womancentered services. There is growing recognition of the importance of including the perspectives of service users and providers to improve quality and organization of care. 2-4 However, the expectations, needs, and values of women and communities have often been neglected in the design of maternity services, particularly in low-and middleincome countries.To address this gap, the WHO initiated the "Better Outcomes in Labour Difficulty" (BOLD) project to improve quality of care during facility-based childbirth. The BOLD project was conducted in Nigeria and Uganda, two settings with a high burden of maternal and neonatal morbidity and mortality. As part of this project, the concept of the "Passport to Safer Birth" (PSB) was developed, its aim to increase

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study

“…The findings suggest that women place high value on positive emotional and interpersonal experiences of care, equally with technical and clinical measures of quality medical interventions, and that optimal use of maternity care could follow from local service design based on these preferences. Results from this study have been integrated into the development of the Passport to Safer Birth . Researchers, policy‐makers, facility administrators, and other stakeholders should integrate women's preferences and values into designing maternity services and should consider the implementation of interventions to promote positive childbirth experiences.…”

Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda

“…The detailed findings of the review of internationally recognized intrapartum care practices were published as part of the 2016 Lancet Maternal Health Series . Quality of facility‐based childbirth care based on the views, needs, expectations, values, and preferences of women and healthcare providers, as well as service models that incorporated the agreed standards are published separately in this Supplement …”

“…The negotiated standards of care have been integrated as the primary component of the Passport to Safer Birth tools . It is envisaged that these standards of care will be adopted and implemented in the study health facilities, when Passport to Safer Birth tools are implemented.…”

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study

“…While women themselves are the “gold standard” for information on their own needs and preferences, healthcare providers and administrators can provide interesting input to explore convergent and divergent perspectives on women's needs. This paper is part of a series on the BOLD project formative research; other aspects of the project are described in detail elsewhere in this Supplement …”