Assessment of facility readiness for implementing the WHO/UNICEF standards for improving quality of maternal and newborn care in health facilities – experiences from UNICEF’s implementation in three countries of South Asia and sub-Saharan Africa

Abstract

BackgroundThere is a global drive to promote facility deliveries but unless coupled with concurrent improvement in care quality, it might not translate into mortality reduction for mothers and babies. The World Health Organization published the new “Standards for improving quality of care for mothers and newborns in health facilities” but these have not been tested in low- and middle-income settings. UNICEF and its partners are taking the advantage provided by the Mother and Baby Friendly Hospital Initiative in Bangladesh, Ghana and Tanzania to test these standards to inform country adaptation. This manuscript presents a framework used for assessment of facility quality of care to inform the effect of quality improvement interventions.MethodsThis assessment employed a quasi-experimental design with pre-post assessments in “implementation” and “comparison” facilities-the latter will have no quality improvement interventions implemented. UNICEF and assessment partners developed an assessment framework, developed uniform data collection tools and manuals for harmonised training and implementation across countries. The framework involves six modules assessing: facility structures, equipment, drugs and supplies; policies and guidelines supporting care-giving, staff recruitment and training; care-providers competencies; previous medical records; provider-client interactions (direct observation); and client perspectives on care quality; using semi-structured questionnaires and data collectors with requisite training. In Bangladesh, the assessment was conducted in 3 districts. In one "intervention" district, the district hospital and five upazilla health complexes were assessed. similar number of facilities were assessed each two adjoining comparison districts. In Ghana it was in three hospitals and five health centres and in Tanzania, two hospitals and four health centres. In the latter countries, same number of facilities were selected in the same number of districts to serve for comparison. Outcomes were structured to examine whether facilities currently provide services commensurate with their designation (basic or comprehensive emergency obstetric and newborn care). These outcomes were stratified so that they inform intervention implementation in the short-, medium- and long-term.ConclusionThis strategy and framework provides a very useful model for supporting country implementation of the new WHO standards. It will serve as a template around which countries can build quality of care assessment strategies and metrics to inform their health systems on the effect of QI interventions on care processes and outcomes.

Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards

“…7 The WHO standards 7 were developed in 2016 and so far very few evaluations using the WHO quality measures have been conducted, with most focused in Africa and Asia. 12 13 In general, existing literature 14 15 suggests that a positive perception of childbirth, including satisfaction with the experience of care, is multidimensional and is influenced by a variety of factors, but none explicitly evaluated the full list of variables, including both indicators of ‘provision of care’, ‘experience of care’ and ‘availability of resources’, as defined by the WHO standards.…”

Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF ‘Every Mother Every Newborn (EMEN)’ standards

“…There is also a demand for a unified quality improvement (QI) model with a standardised model of service delivery, monitoring and accountability 18 19. To address this global imperative, the Every Mother Every Newborn QI (EMEN-QI) initiative was created 20 21. Ten EMEN ‘standards’ were developed to guide how health facilities provide evidence-based care to mothers and newborns with ‘criteria’ to measure these standards (online supplementary appendix S1).…”

“…Ten EMEN ‘standards’ were developed to guide how health facilities provide evidence-based care to mothers and newborns with ‘criteria’ to measure these standards (online supplementary appendix S1). 22 These standards are being tested in three countries—Ghana, Tanzania and Bangladesh—taking advantage of the ongoing Mother and Baby Friendly Hospital Initiative funded by the Bill and Melinda Gates Foundation and UNICEF 21. In Bangladesh, the initiative is being implemented jointly by the Government of Bangladesh (GoB), UNICEF headquarters and UNICEF Bangladesh 21…”

Translating international guidelines for use in routine maternal and neonatal healthcare quality measurement

“…Participants in our study agreed that a set of metrics to guide quality improvement is necessary; however, the current WHO indicators create a burden of measurement that may only work to overwhelm the current health system in Bangladesh. In an ongoing study in Bangladesh, Ghana, and Tanzania, an assessment of facility readiness for implementing the WHO QoC Standards may help identify existing barriers to introducing quality improvement interventions in health systems in LMICs [37]. Citing systemic challenges in service delivery, participants commented on the need to prioritize indicators within the reduced list even further.…”