Developing global indicators for quality of maternal and newborn care: a feasibility assessment

Abstract

ObjectiveTo assess the feasibility of applying the World Health Organization’s proposed 15 indicators of quality of care for maternal and newborn health at health-facility level in low- and middle-income settings.MethodsSix of the indicators are about maternal health, five are for newborn health and four are general cross-cutting indicators. We used data collected routinely in facility registers and obtained as part of facility assessments from 963 health-care facilities specializing in maternity services in 10 countries in Africa and Asia. We made a feasibility assessment of the availability of data and the clarity of indicator definitions and identified additional information and data collection processes needed to apply the proposed indicators in real-life settings.FindingsOf the indicators evaluated, 10 were clearly defined, of which four could be applied directly in the field and six would require revisions to operationalize them. The other five indicators require further development, with one of them being ready for implementation by using information readily available in registers and four requiring further information before deployment. For indicators that measure coverage of care or availability of services or products, there is a need to further strengthen measurement. Information on emergency obstetric complications was not recorded in a standard manner, thus limiting the reliability of the information.ConclusionWhile some of the proposed indicators can already be applied, other indicators need to be refined or will need additional sources and methods of data collection to be applied in real-world settings.

Implementing the WHO integrated tool to assess quality of care for mothers, newborns and children: results and lessons learnt from five districts in Malawi

“…It is essential that partners prioritise alignment of quality of care assessment tools. The recent development and testing by WHO and partners of a core set of harmonized maternal newborn and child health indicators is a step in the right direction, but the final indicators need to be rapidly integrated into existing tools [ 4 ]. In addition, as with any new tool developed by international agencies, it is imperative that the standards on which the tools are based are accepted by healthcare workers and established in the local context as realistic.…”

“…Leaders of global health agencies have agreed an agenda for better measurement of the quality of healthcare and aim to align the various efforts, reduce the burden of data collection and reporting for countries and improve linkage of results with decision-making. New tools for the assessment of quality have been developed and international consensus reached on indicators for quality of care in maternal, newborn and child health [ 4 , 5 ].…”

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

“…Fortunately, maternal blood pressure (BP) is easily measured even in remote settings. It is considered as an indicator of quality antenatal care (1) and useful in predicting hypertensive disorders of pregnancy (HDPs), preterm-birth and small-for-gestational-age (SGA) infants (2). In addition to systolic and diastolic blood pressure (SBP and DBP), both mean arterial pressure (MAP), and pulse pressure (PP) (3) also have clinical value.…”

Coverage of the WHO’s four essential elements of newborn care and their association with neonatal survival in southern Nepal

“…In an effort to continue the progress made in reducing maternal, child and neonatal mortality, the global community has recognized that in going forward with the SDGs there needs to be a focus on quality of care measurement [ 5 ]. For this purpose, the World Health Organization (WHO) developed and released a list of global indicators for maternal and newborn care in 2014, one of which is the “proportion of newborns who received all four elements of essential care”, which are as follows: immediate and thorough drying, immediate skin-to-skin contact, delayed cord clamping and initiation of breast feeding within the first hour [ 6 ].…”