Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

Tamburlini, Giorgio; Yadgarova, K.; Kamilov, A.; Bacci, Alberta

doi:10.1371/journal.pone.0078282

Cited by 16 publications

(12 citation statements)

References 13 publications

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“…46 The findings and lessons learnt from this study need to be taken forward as part of this WHO-led initiative and will be critical for advancing and supporting ministries of health to harmonise and lead quality improvement approaches across the health system. We hope that this paper will influence this important mechanism.…”

Section: Discussionmentioning

confidence: 92%

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

et al. 2017

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ObjectiveTo present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills.DesignCross-sectional observational health facility assessment.SettingEthiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania.ParticipantsHealth workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed.Main outcome measuresIndicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation.ResultsSterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly.ConclusionsThe findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives.

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Section: Discussionmentioning

confidence: 92%

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

et al. 2017

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“…The Health Facility Survey, developed by the WHO Department of Child and Adolescent Health and Development in 2003, is based on the Integrated Management of Childhood Illness (IMCI) clinical guidelines [14] and has been used in various settings including rural Ghana [15] and Afghanistan [16]. The Hospital Care for Mothers and Newborn Babies quality assessment and improvement tool is a comprehensive systematic, standards-based, participatory approach instrument developed by the WHO Regional Office for Europe first published in 2009, revised in 2014 [17] and has been employed both in Europe [18] as well as in lower resource settings [19]. Integration of the two surveys generated a generic assessment tool to evaluate quality of care for mothers, babies as well as children in hospital settings.…”

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

Assessing quality of newborn care at district facilities in Malawi

Kawaza

Kinshella

Hiwa

et al. 2020

BMC Health Serv Res

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Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methods: These facility assessments were part of the "Integrating a neonatal healthcare package for Malawi" project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

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“…In 2014, the WHO Integrated Maternal, Neonatal and Child Quality of Care Assessment and Improvement Tool was developed from two existing survey instruments, the Health Facility Survey tool to evaluate the quality of care delivered to sick children and the Hospital Care for Mothers and Newborn Babies quality assessment and improvement tool (13) (14) and has been used in various settings including rural Ghana (15) and Afghanistan (16). The Hospital Care for Mothers and Newborn Babies quality assessment and improvement tool is a comprehensive systematic, standards-based, participatory approach instrument developed by the WHO Regional Office for Europe first published in 2009, revised in 2014 (17) and has been employed both in Europe (18) as well as in lower resource settings (19). Integration of the two surveys generated a generic assessment tool to evaluate quality of care for mothers, babies as well as children in hospital settings.…”

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

Assessing Quality of Newborn Care at District Facilities in Malawi

Kawaza¹,

Kinshella

Hiwa

et al. 2020

Preprint

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Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

show abstract

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

Cited by 16 publications

References 13 publications

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

Assessing quality of newborn care at district facilities in Malawi

Assessing Quality of Newborn Care at District Facilities in Malawi

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