Abstract
BackgroundA variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example.MethodsWe first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi.ResultsOur strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks.ConclusionThe identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs.
Highlights
Maternal and neonatal deaths are largely preventable, but still very common in low- and middle-income countries (LMICs)
To allow comparison across maternal and neonatal health (MNH) programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation
Using data from a recent routine care process assessment conducted in Malawi, we evaluate how well our indicator set performed in terms of applicability and information gain in a LMICS setting
Summary
Maternal and neonatal deaths are largely preventable, but still very common in low- and middle-income countries (LMICs). In 2013 NMR estimates ranged from 2 deaths per 1,000 live births for early and less than 1 death per 1,000 live births for late neonatal mortality in developed nations, while these rates for developing regions were estimated as 13 and 4 deaths per 1,000 live births, respectively; with 20 and almost 7 deaths per 1,000 live births, respectively in the SSA region [2]. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
