Leadership, action, learning and accountability to deliver quality care for women, newborns and children

Abosede, Adeniran; Likaka, Andrew; Knutsson, Anneka; Costello, Anthony; Daelmans, Bernadette; Maliqi, Blerta; Burssa, Daniel; Freer, Joseph; Askew, Ian; Bowen, Lisa; Kak, Lily; McDougall, Lori; Zaka, Nabila; Tunçalp, Özge; Tenhoope-Bender, Petra; Syed, Shamsuzzoha B; Peterson, Stefan; Luchesi, Thiago; Zeck, Willibald; Were, Wilson; Barker, Pierre; Naimy, Zainab

doi:10.2471/blt.17.197939

Cited by 14 publications

(15 citation statements)

References 7 publications

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“…Further analyses are in progress to develop consolidated measurement scales, which might be more practical for targeted monitoring and quality improvement. Within country implementation, the Quality of Care Network is standardising measurement of women's maternity care experiences, and nine low-income and middle-income countries are currently testing these tracer indicators 1, 47…”

Section: Discussionmentioning

confidence: 99%

How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

et al. 2019

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SummaryBackgroundWomen across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries.MethodsWe prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment.Findings2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15–19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6–8·0) and younger women with some education (OR 1·6, 1·1–2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity.InterpretationMore than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context.FundingUnited States Agency for International Development and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.

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Section: Discussionmentioning

confidence: 99%

How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

et al. 2019

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“…In a related field, the WHO-led Network for Improving Quality of Care for Maternal Newborn and Child Health Care is driving the approach of moving care away from NGO-led, fragmented, and often unsustainable individual QI projects toward country-led initiatives. 52 WHO is also providing guidance to governments on how to design and organize national QI programming through development of their national quality policy and strategies, an approach that supports embedding QI in ART programmes within the context of a national quality policy and strategy in support of broader universal health coverage goals 53,54 across HIV programs globally. 52…”

Section: Discussionmentioning

confidence: 99%

“…52 WHO is also providing guidance to governments on how to design and organize national QI programming through development of their national quality policy and strategies, an approach that supports embedding QI in ART programmes within the context of a national quality policy and strategy in support of broader universal health coverage goals 53,54 across HIV programs globally. 52…”

Section: Discussionmentioning

confidence: 99%

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

Hargreaves

Rustage

Nellums

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Patient experience indicators are currently used to target quality improvement for maternal health care across nine countries within the Network for Improving Quality of Care for Maternal, Newborn and Child Health 13 . One focus of the network is to improve support for women during labour and childbirth from a companion of her choice (such as a partner, sister or friend).…”

Section: Choosing Person-centred Measuresmentioning

confidence: 99%

When the patient is the expert: measuring patient experience and satisfaction with care

Larson

Sharma

Bohren

et al. 2019

Bull. World Health Organ.

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In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.

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Leadership, action, learning and accountability to deliver quality care for women, newborns and children

Cited by 14 publications

References 7 publications

How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

When the patient is the expert: measuring patient experience and satisfaction with care

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