Maternal and neonatal services in Ethiopia: measuring and improving quality.

Maureen E Canavan,Marie A Brault,Erika Linnander,Dawit Tatek,Ayele Teshome,Daniel Burssa,Elizabeth H Bradley

doi:10.2471/blt.16.178806

Maureen E Canavan, Marie A Brault + Show 5 more

Open Access

https://doi.org/10.2471/blt.16.178806

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Abstract

ProblemMaternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress.ApproachWe developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services.Local settingEthiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals.Relevant changesSignificant improvements in quality of intrapartum care were detected from baseline (June–July 2015) to follow-up (February–March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001).Lessons learntThe method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.

Highlights

Maternal mortality remains high in most low-and middleincome countries, and poor quality of intrapartum care limits further progress.[1,2]
Studies of the quality of maternal and neonatal care in low- and middle-income countries largely focus on evaluating the quality of a single intervention[6,8] rather than multiple aspects of intrapartum care, and often in one hospital at a single point in time, limiting the generalizability of the findings
We sought to develop and test a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative

Summary

Lessons froLmessontshfroem field the field

Maureen E Canavan,a Marie A Brault,a Dawit Tatek,a Daniel Burssa,b Ayele Teshome,b Erika Linnandera & Elizabeth H Bradleya. Problem Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Relevant changes Significant improvements in quality of intrapartum care were detected from baseline (June–July 2015) to follow-up (February–March 2016) in targeted hospitals. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. This tool may be useful in other low- and middle-income countries

Introduction

Local setting

Relevant changes

Lessons learnt

Findings

Infection protection and patient safety