Quality of care in institutional deliveries: the paradox of the Dominican Republic: a commentary on management

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This paper shows that management failures are responsible for continued high maternal mortality ratio (MMR) in the Dominican Republic (DR) in spite of the fact that 97% of the deliveries take place in institutions. Poor quality care does not lower the MMR. If women with complications are not getting the required expert care then simply delivering in a hospital will not help to save their lives. Unfortunately the DR is not alone among developing countries in the area of poor management of hospitals. Many countries have similar problems but because of their high home delivery rate they feel that their high MMR is because of non-availability of institutional care. It is assumed that institutional care implies high quality care. Miller and her colleagues have shown that it is not necessarily true and that in spite of moderately high national incomes hospitals can be poorly managed. Unless specific measures are taken to improve it the quality of care will remain poor as seen by example of the DR. The key management lesson from this report from the DR is that just increasing institutional deliveries alone may be no help unless high quality care of women with complications is assured. This is a major management challenge. Agencies like the World Bank bilateral donors and technical agencies like WHO and PAHO need to pay much more attention than they presently do to improving management of hospitals and quality of care if MMR is to decline—just providing material goods will not be enough. (excerpt)