The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'

PLoS One. 2015 Apr 15;10(4):e0123968. doi: 10.1371/journal.pone.0123968. eCollection 2015.

Abstract

Background: A 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.

Methods: We 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.

Results: Our 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.

Conclusion: The 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Communicable Diseases / diagnosis
  • Communicable Diseases / therapy
  • Delivery, Obstetric
  • Developing Countries
  • Emergency Medical Services / economics
  • Emergency Medical Services / organization & administration
  • Female
  • Health Facilities* / economics
  • Humans
  • Infant, Newborn
  • Malawi
  • Perinatal Care / statistics & numerical data*
  • Postpartum Hemorrhage / diagnosis
  • Postpartum Hemorrhage / therapy
  • Postpartum Period / physiology
  • Pre-Eclampsia / diagnosis
  • Pre-Eclampsia / therapy
  • Pregnancy
  • Quality Indicators, Health Care / statistics & numerical data*
  • Quality of Health Care*
  • Risk Factors
  • Workforce

Grants and funding

This research project is made possible through Translating Research into Action, TRAction, and is funded by United States Agency for International Development (USAID) under cooperative agreement number GHS-A-00-09-00015-00. The project team includes prime recipient, University Research Co., LLC (URC), Harvard University School of Public Health (HSPH), and sub-recipient research organization, University of Heidelberg. This research project is co-funded through a grant by the Norwegian Ministry of Foreign Affairs to the Government of Malawi under Programme Title MWI 12/0010 Effect Evaluation of Performance Based Financing in Health Sector. The Malawi College of Medicine as implementing institution is recipient of this grant. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.