In 2014 the World Health Organization (WHO) developed a new tool to be used to assess the quality of care for mothers, newborns and children provided at healthcare facility level. This paper reports on the feasibility of using the tool, its limitations and strengths.
Across 5 districts in Malawi, 35 healthcare facilities were assessed. The WHO tool includes checklists, interviews and observation of case management by which care is assessed against agreed standards using a Likert scale (1 lowest: not meeting standard, 5 highest: compliant with standard). Descriptive statistics were used to provide summary scores for each standard. A ‘dashboard’ system was developed to display the results.
For maternal care three areas met standards; 1) supportive care for admitted patients (71% of healthcare facilities scored 4 or 5); 2) prevention and management of infections during pregnancy (71% scored 4 or 5); and 3) management of unsatisfactory progress of labour (84% scored 4 or 5). Availability of essential equipment and supplies was noted to be a critical barrier to achieving satisfactory standards of paediatric care (mean score; standard deviation: 2.9; SD 0.95) and child care (2.7; SD 1.1). Infection control is inadequate across all districts for maternal, newborn and paediatric care. Quality of care varies across districts with a mean (SD) score for all standards combined of 3 (SD 0.19) for the worst performing district and 4 (SD 0.27) for the best. The best performing district has an average score of 4 (SD 0.27). Hospitals had good scores for overall infrastructure, essential drugs, organisation of care and management of preterm labour. However, health centres were better at case management of HIV/AIDS patients and follow-up of sick children.
There is a need to develop an expanded framework of standards which is inclusive of all areas of care. In addition, it is important to ensure structure, process and outcomes of health care are reflected.
World Health Organization. Every newborn: an action plan to end preventable deaths. Geneva: World Health Organization; 2014. https://www.everynewborn.org/every-newborn-action-plan/
World Health Organization. The global strategy for women’s, children’s and adolescents’ health (2016–2030). Geneva: World Health Organization; 2015. http://globalstrategy.everywomaneverychild.org/
United Nations. Every woman, every child. New York: United Nations; 2016. http://www.everywomaneverychild.org/
World Health Organization and Partnership for Maternal, Newborn and Child Health. Consultation on improving the measurement of the quality of maternal, newborn and child care in facilities. Geneva: World Health Organization; 2014. http://apps.who.int/iris/bitstream/10665/128206/1/9789241507417_eng.pdf
World Bank. Service delivery indicators: methodology. Washington D.C.: World Bank; 2013. http://www.sdindicators.org/methodology
World Health Organization. Service Availability and Readiness Assessment (SARA): an annual monitoring system for service delivery: Reference manual. Geneva: World Health Organization; 2015.
World Health Organization. Health Facility Survey: tool to evaluate the quality of care delivered to sick children attending outpatients facilities. Geneva: World Health Organization; 2003.
World Health Organization Regional Office for Europe. Hospital care for mothers and newborn babies: quality assessment and improvement tool (second edition). Denmark: WHO Regional Office for Europe; 2014.
Ministry of Health. Malawi Standard Treatment Guidelines. 5th ed. Lilongwe: Government of Malawi; 2015.
World Health Organization. Pocket book of hospital care for children: Guidelines for the management of common illnesses with limited resources. Geneva: World Health Organization; 2005. http://www.who.int/maternal_child_adolescent/documents/9241546700/en/
Hulton L, Matthews Z, Stones RW. A framework for the evaluation of quality of care in maternity services. Southampton: University of Southampton; 2000.
Simmons R, Elias C. The study of client-provider interactions: a review of methodological issues. Stud Fam Plan. 1999;25:1–17. CrossRef
Souza JP, Gulmezoglu AM, Vogel J, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multi-country Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:747–55. CrossRef
Tamburlini G, Yadgarova K, Kamilov A, et al. The maternal and neonatal care quality improvement working group. Improving the quality of maternal and neonatal care: the role of standard based participatory assessments. PLoS ONE. 2013;8:e78282. 10.1371/journal.pone.0078282. CrossRefPubMedPubMedCentral
Raven J, Hofman J, Adegoke A, van den Broek N. Methodology and tools for quality improvement in maternal and newborn health care. Int J Gynecol Obstet. 2011;114:4–9. CrossRef
STAR-E, USAID, MSH, and John Snow Inc. Uganda Health Facility Assessment report. 2013; http://www.starelqas.ug/wp-content/uploads/Bugiri-District-HFA-.pdf
- Implementing the WHO integrated tool to assess quality of care for mothers, newborns and children: results and lessons learnt from five districts in Malawi
Atnafu Getachew Asfaw
Kyaw Myint Aung
Nynke van den Broek
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II