Electronic supplementary material
Establishing standards for women friendly care
Workshop 1: Establish standards for women friendly care
Workshop 2: Review and finalise the standards initially developed
1. All pregnant women are received in the labour ward in a cordial manner
• staff with good interpersonal communication skills
• identification badges for staff
• dedicated space with a bed to receive the pregnant woman
• staff wear identification badges
• clients are welcomed
• clients are greeted by name.
• staff introduce themselves to clients by name
• staff use a language the client can understand
• staff orient the woman to the labour ward/room set up
• at least 80% of women are satisfied with the reception they received at the labour ward
2. All staff have a positive attitude towards all clients
• staff with skills on interpersonal communication and counselling
• staff with a positive attitude on labour ward, post natal ward, antenatal ward and clinic
• clients are welcomed
• clients are greeted by name.
• staff introduce themselves to clients by name
• all procedures done (e.g. during labour or on the ward care) are explained by staff to the client
• client is allowed to have a companion with her during labour and delivery.
• clients are told how and where they can ask for assistance
• patients are referred to and called by their name (and not by bed number, diagnosis etc)
• staff are polite and use appropriate language
• client satisfaction of at least 80%
• at least 80% of women understand the procedures undergone during labour, delivery and puerperium
• at least 80% of women willing to deliver again at the at the same facility in a subsequent pregnancy
• 95% of women will recommend the facility to other women
• 95% of women will feel they are treated with dignity and respect
3. The cultural background of women is respected with regard to staff attitude, care during labour and delivery environment
• staff who are aware of and sensitive to the cultural background of clients
• user friendly furniture especially labour bed
• curtains and screens
• community and clients aware that a woman is allowed and encouraged to have a companion during labour and delivery
• identified companion who can be present during labour and delivery
• identified space for patients to be able to interact (socialise) during hospital care
• clients' opinions are sought
• staff greet clients, introduce themselves and asks about clients needs and wellbeing
• labour ward environment is modified to meet the needs of the client
• where possible use a low bed – if this is not possible explain why a high bed is needed and ensure client can easily climb on the bed
• curtains and screens are used to help provide privacy.
• clients are not exposed unnecessarily and covered with linen (unless they do not want this)
• staff allow a companion to be present during labour and delivery
• community and clients are informed of that having a companion during labour and delivery is allowed and of benefit.
• staff identify space for clients where they can walk around, sit, socialise etc. during hospital care and encourage clients to use this.
• 'Visio therapy' (e.g. information pamphlets TV or radio) are available for clients during their stay in the facility
• clients feel their cultural background is respected
• clients feel they are recognised as being unique
• clients and community are satisfied with care given at the facility
• women delivering at the facility will feel as comfortable as at home
• women delivering at the facility will have a companion wit them during labour and delivery
• women will enjoy their waiting time/time at the facility learn something new
• increased number of women deliver at the facility (with skilled attendant)
4. All women coming to maternity ward have the right to be treated with respect and dignity
• all staff members have good communication skills
• all staff are trained in patient rights, health care provider rights and responsibilities and interpersonal communication skills.
• Linen, curtains, screens
• staff receive training about patient rights, health workers rights and responsibilities and in interpersonal communication skills
• staff communicate properly and are polite to clients
• staff introduce themselves, call client by name, explain produces to be done, obtain informed consent, use appropriate language and allow clients to verbalise their feelings
• linen, screens and curtains are used to ensure privacy: 'clients are not exposed anyhow'
• every woman attending the facility will feel they are respected, recognised as unique and treated with dignity.
• women will not feel they have been exposed unnecessarily
• women will be satisfied with the care they receive
• deliveries at the facility (by skilled attendant) will increase.
5. Every woman should be attended to within 30 minutes of their arrival at the facility.
• volunteers, porters, drivers, guards who are aware of the need to escort clients to appropriate wards
• clear directions to labour ward (and emergency ward)
• direct admission to labour ward possible (i.e. not having to go to records office etc first)
• skilled knowledgeable staff available 24 hours 7 days.
• emergency obstetric care equipment and supplies available 24 hours 7 days.
• women in labour or with pregnancy related complications are identified and escorted to the labour ward (or relevant emergency room) at point of entry to the facility.
• Support staff as well as health care providers are made aware of the need to and possibility of direct admission to the labour ward (or emergency room) for women in labour and/or with pregnancy related complications.
• all staff on labour ward and emergency room commence management of patient when she arrives
• protocols for management of women requiring emergency obstetric care and/or in labour are in place
• delays will be reduced
• patients will feel welcome
• client flow improved
• clients will be attended to properly
• 90% of women are assessed and initial treatment commenced within 30 minutes
6. All mothers are provided with an enabling environment.
• safe and clean environment (labour ward, emergency room) ready 24 hours 7 days.
• cleaning material and disinfectant
• agreed protocol for cleaning of labour ward/emergency room.
• functioning and adequate bathrooms, toilets, washing area, guardian shelter, kitchen space
• adequate number of skilled attendants
• staff keep labour room, beds, toilets, bathroom, floors, windows, walls and linen clean.
• clients are provided with functioning and adequate bathrooms, toilets, washing area, guardian shelter, kitchen space
• increase in number of women attending the facility
• reduced infection rates
• increased client satisfaction
7. All clients to be informed of the services and treatment alternatives available at the facility
• IEC material (posters, leaflets, banners)
• staff with knowledge and awareness about treatment alternatives and able to inform client in her/his own language of choices
• IEC material used
• health talks on services available are given eg during antenatal clinics, via drama, via media (radio/TV and newspapers)
• services explained to client by health care provider
• treatment alternatives explained to client by health care provider
• health care provider takes client's choice into consideration
• increased service utilization
• improved provider/client relationship
• clients able to make an informed choice
• health care providers create a learning environment as they will themselves need to learn about treatment alternatives available.
• increased working satisfaction for health care providers
8. Each client is treated according to her individual needs
• paper, pen (case notes)
• staff able to take history
• staff able to make management plan and implement
• curtains and screens for privacy
• labour room with conditions conducive for individualised delivery care
• client is addressed by name and the health care provider introduces him/herself to the client
• curtains and screens are used and the client is covered with linen when examined etc.
• a proper and complete history is taken for each client, including:
○ personal data (name, address, age, marital status, religion)
○ obstetric history
• information obtained is actually used to decide on a management plan for the client and the management is implemented.
• staff allow guardian in labour room and explain procedures
• clients are allowed to adopt the delivery position of their choice (e.g. squatting, supine, kneeling)
• pain relief measures are given during labour (back rubs, walking, drugs, reassurance)
• reduced number of maternal death
• individual case note available
• improved rapport with client
• every woman attended to at the health facility feels she has been treated with dignity and respect
9. At the facility a woman receives skilled attendance at birth and emergency obstetric care when required.
• skilled staff available.
• Emergency obstetric care equipment and supplies available on the labour ward and emergency room (including an emergency tray).
• staff and supplies available 24 hours a day, 7 days a week.
• in-service training of staff on emergency obstetric care is conducted with regular updates.
• all necessary drugs needed for delivery and emergency obstetric care are ordered in a timely manner and checks for availability are in place.
• proper handovers are conducted.
• patients are informed patients of services available and these are provided to them as and when necessary.
• 95% of women who come to the facility in labour or with complications requiring emergency obstetric care will have skilled attendance and emergency obstetric care provided to them as and when required.
• increased uptake of skilled attendance and emergency obstetric care.
10. All client information will be treated with confidentiality and discretion
• staff that can maintain confidentiality
• staff use low tone in communication
• clients opinion is sought regarding disclosure of information
• clients records and condition are kept confidential (verbal and written)
• every woman attended to at the health facility feels that her information will be kept confident
11. All health workers to ensure proper management of patient information
• skilled staff on information management
• data entry clerks
• enough stationery (registers, papers, pens, computers, files)
• lockable drawers
• orient staff on the necessity for proper recording of information: 'if it is not recorded, it did not happen'
• all health care providers record all activities that are carried out for the patient.
• recorded information is used (e.g. case notes referred to, used in handovers etc).
• health care providers ensure that data tools are available (registry books, tally sheets, stationery, partograph, case notes etc)
• all patient information is kept confidential and safe
• good data available for audit
• improved information driven decision making for all women who have been seen at the health facility there is a complete and accurate set of notes.
• registry books (e.g. labour ward register) accurately reflect what activity there is at the health centre
Workshop 3: Select criteria to audit
A survey of providers' attitudes towards criterion based audit
Agreed standards for women friendly care
Criteria selected to audit in the first six months
1. Health worker greets all women when they arrive the health facility
2. Health worker introduces him/herself to women when they arrive the health facility
3. Health worker informs and allows all pregnant women to have a companion of their choice during labour
4. Health worker uses linens to cover women and ensure privacy during labour
5. Health worker uses curtains or screens to ensure privacy during labour and delivery
6. Health worker calls women or refer to them by their names and not by other names (e.g. bed number or diagnosis)
7. Health worker keeps the maternity ward clean (i.e. beds, floors, windows, walls, lines)
8. Health worker provides women with a clean bathroom and toilet
9. Health worker informs women of the different birthing positions (e.g. squatting, supine, kneeling)
10. Health worker allows women to adopt the birthing position of your choice (e.g. squatting, supine, kneeling)
11. Health worker speaks the language that is easy for women to understand
12. Health worker respects all women and treat them with dignity
13. At least 80% of women are satisfied with the care they receive in the health facility
14. At least 95% of women will recommend the health facility to a friend or relative
Attitudes of health professionals towards criterion based audit
Number of participants who agree with the proposition (N = 54)
Percentage (95% Confidence Interval)
Criterion based audit will improve the quality of care
Criterion based audit is a good educational tool
Criterion based audit will reduce the health care costs
Criterion based audit cannot be done routinely because it is time-consuming
Criterion based audit will increase law suits against health care providers
Criterion based audit will create a feeling of blame among providers
Manager will use audit to identify and punish providers who fail to meet standards