Abstract
BackgroundGaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments.MethodsImprovements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment.ResultsBetween the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics.ConclusionsImportant improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.
Highlights
Substandard quality of maternal and neonatal care seriously hampers the achievement of desired health outcomes, impedes the fulfilment of women’s and babies’ rights, and causes inefficiency and unjustified direct and indirect costs for the households [1,2,3]
We report the results of a nation-wide effort to improve quality of maternal and neonatal hospital care in Uzbekistan, a lower-middle income country with high coverage of antenatal and delivery care, focusing on the role played by standardbased participatory assessments proposed by WHO [2]
We were able to document important improvements in the quality of care provided to mother and newborn babies in busy perinatal referral centres of a lower-middle income country over a short period of time
Summary
Substandard quality of maternal and neonatal care seriously hampers the achievement of desired health outcomes, impedes the fulfilment of women’s and babies’ rights, and causes inefficiency and unjustified direct and indirect costs for the households [1,2,3]. We report the results of a nation-wide effort to improve quality of maternal and neonatal hospital care in Uzbekistan, a lower-middle income country with high coverage of antenatal and delivery care, focusing on the role played by standardbased participatory assessments proposed by WHO [2]. Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. Conclusions: Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process
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