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

Smith, Helen; Asfaw, Atnafu Getachew; Aung, Kyaw; Chikoti, Lastone; Mgawadere, Florence; D’Aquino, Luigi; Broek, Nynke van den

doi:10.1186/s12884-017-1461-y

Cited by 26 publications

(62 citation statements)

References 10 publications

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“…on Excel were used to analyze summary scores for each area of care. Following Smith and colleagues (13), standards were considered to have been met if scored four or five.…”

Section: Discussionmentioning

confidence: 99%

“…In 2014, the WHO integrated quality of care assessment tool was developed from two existing survey instruments, the Health Facility Survey tool to evaluate the quality of care delivered to sick children and the Hospital Care for Mothers and Newborn Babies quality assessment and improvement tool (13). The Health Facility Survey, developed by the WHO Department of Child and Adolescent Health and Development in 2003, is based on the Integrated Management of Childhood Illness (IMCI) clinical guidelines (14) and has been used previously in various settings including rural Ghana (15) and…”

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

“…Afghanistan (16). The Hospital Care for Mothers and Newborn Babies quality assessment and improvement tool is a comprehensive systematic, standards-based, participatory approach instrument developed by the WHO Regional Office for Europe first published in 2009, revised in 2014 (17) and has been employed both in Europe (18) as well as in lower resource settings (19) (13). To the best of our knowledge, our study is the second time it has been used in Malawi.…”

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

“…Aspects of care observed by data collectors were scored on a Likert scale from one to five. A score of five indicated good practice complying with standards of care recommended by the WHO, a score of four indicated minor need for improvement to reach standard of care, a score of three indicated some need for improvement, a score of two indicated considerable need and a score of one indicated totally inadequate care or a potentially life-threatening practice (13,20,21). Open-ended comments were elicited from data collectors following each section to reflect on the strengths and weaknesses as observed.…”

Section: Administering the Facility Assessmentmentioning

confidence: 99%

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Assessing Quality of Newborn Care at District Facilities in Malawi

Kawaza¹,

Kinshella

Hiwa

et al. 2020

Preprint

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Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

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“…on Excel were used to analyze summary scores for each area of care. Following Smith and colleagues (13), standards were considered to have been met if scored four or five.…”

Section: Discussionmentioning

confidence: 99%

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

Section: Adaptation Of the Who Integrated Quality Of Care Assessment mentioning

confidence: 99%

Section: Administering the Facility Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Assessing Quality of Newborn Care at District Facilities in Malawi

Kawaza¹,

Kinshella

Hiwa

et al. 2020

Preprint

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“…The Toolkit includes a clinic implementation guide, group antenatal care training and facilitation guide, benchmarks, a training video, and interactive learning materials. Although the Toolkit can be used alone, research shows that implementation proceeds more quickly and with greater fidelity when supportive consultation and interactive assistance is provided [62][63][64][65][66]. To help with planning and resolving emerging challenges, our implementation team provides intensive and supportive consultation and interactive assistance each week as each clinic prepares and during the first 2 months of rollout of the group antenatal care model.…”

Section: Intervention: Group Antenatal Care Implementation Toolkitmentioning

confidence: 99%

An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi

et al. 2020

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Background: Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes.Methods: Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. Discussion: This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. Trial registration: ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.

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