WHO Quality of Care Vision | 16 April 2015 1 |

Improving quality of care for mothers and newborns

WHO Quality of Care Vision | 16 April 2015 2 |

Quality of care matters

Due to focused efforts, facility-based deliveries is increasing globally • Higher proportion of avoidable maternal and perinatal morbidity

and mortality occur in facilities

Major roadblock: Quality of care

Coverage of essential interventions is not enough • WHO Multi-country study 2013

Provision of care as important as the experience of care Barriers and facilitators to facility-based deliveries

Right to health • iERG: "quality of care is the route to equity and dignity for

women and children"

WHO Quality of Care Vision | 16 April 2015 3 |

Every mother and newborn receives quality care

throughout pregnancy, childbirth and the postnatal period

Preamble:

Efforts towards Universal Health Coverage aim to provide all mothers and newborns with

access to the health care system

WHO vision

WHO Quality of Care Vision | 16 April 2015 4 |

Investing in care around the time of childbirth:

a triple return on investment

Focus period:

Pregnancy care Care around childbirth for

for women and newborns Care for the small and sick

newborns

WHO Quality of Care Vision | 16 April 2015 5 |

Detection of nutritional deficiencies, infections, pre-eclampsia and medical conditions

Promotive and preventive care

Antenatal care

Labour and childbirth care

Labour monitoring and action

Childbirth care (incl. companion)

Newborn care at birth

Postnatal newborn care

First week: exclusive BF, warmth, cord care, hygiene

Postnatal maternal care

Routine monitoring

Counselling: BF, contraception, nutrition…

Anemia, medical disorders, infections: Immediate treatment

Preterm/LBW newborn: Kangaroo Mother Care, BF support

Labour difficulty: augmentation, assisted delivery or CS.

PPH: therapeutic uterotonics, blood transfusion, surgery

Pre-clampsia/ eclampsia*: Magnesium sulfate, antihypertensive, prompt delivery

Suspected maternal and newborn sepsis: Early antibiotic treatment

Preterm labour: Corticosteroids

Not breathing at birth: Resuscitation

Essential and additional care during the focus period

WHO Quality of Care Vision | 16 April 2015 6 |

Definition of quality of care

The extent to which health services provided to individuals

and populations improve desired health outcomes.

In order to achieve this, health care needs to be

WHO Quality of Care Vision | 16 April 2015 7 |

Characteristics of quality care

Safe – delivering health care which minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors

Effective – providing services based on scientific knowledge (WHO guidelines)

Timely – reducing delays in providing/receiving health care

Efficient – delivering health care in a manner which maximizes resource use and avoids wastage

Equitable – delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status;

People-centered – providing care which takes into account the preferences and aspirations of individual service users and the cultures of their communities

WHO Quality of Care Vision | 16 April 2015 8 |

Health systems framework

Systems thinking for health systems strengthening (2009)

WHO Quality of Care Vision | 16 April 2015 9 |

Health system

Individual and facility-level outcomes Coverage of key practices People-centred outcomes

Health outcomes

EXPERIENCE OF CARE

4. Effective communication

5. Respect and dignity

6. Emotional support

Quality of Care

7. Competent and motivated human resources

PROVISION OF CARE 1. Evidence based practices for

routine care and management of complications

2. Actionable information systems

3. Functional referral systems

Stru

ctur

e

Proc

ess

O

utco

me

8. Essential physical resources available

WHO Quality of Care Vision | 16 April 2015 10 |

Priority evidence-based practices With essential childbirth care including labour monitoring and action and essential newborn care at birth and during the first week as the foundation:

Management of pre-eclampsia, eclampsia and its complications;

Management of postpartum haemorrhage;

Management of difficult labour by enabling safe and appropriate use of medical technologies during childbirth;

Newborn resuscitation;

Management of preterm labour, birth and appropriate care for preterm and small babies;

Prevention and management of maternal and newborn infections.

WHO Quality of Care Vision | 16 April 2015 11 |

QoC improvement strategy

Institutionalizing efforts under government leadership

Adaptation and overcoming barriers to implementation

Responding to contextual differences

Selection of effective intervention strategies

Roadmap for continuous and sustainable quality improvement

6. Measurement of quality & outcomes

4. Identify interventions & Set Goals

1. Establish leadership group 2. Situation analysis / assessment 3. Adapt service delivery standards

7. Refinement of strategies

5. Implementation of interventions

PLAN

DO

STUDY

ACT

WHO Quality of Care Vision | 16 April 2015 12 |

PDSA cycle

Plan

Do Study

Act

Identify interventions and set goals

Implement interventions & strategies

Assess process and outcomes, analyze results

Refine strategies and scale up best practices

PLAN

DO

STUDY

ACT

WHO Quality of Care Vision | 16 April 2015 13 |

Capacity Strengthening

6. Measurement of quality & outcomes

4. Identify interventions

1. Establish leadership group 2. Situation analysis / assessment 3. Adapt service delivery standards

7. Refinement of strategies

5. Implementation of interventions

PLAN

DO

STUDY

ACT

WHO Guidelines

Evidence-based intervention strategies to improve QoC

Service delivery standards

Research

Measurement indicators and methods

Quality of Care Framework

Developmental work in pipeline

Quality statement:

Newborn resuscitation with bag and mask is effectively initiated in the newborn not breathing at birth, within one minute after birth, if no spontaneously breathing after additional stimulation.

Quality measures/criteria:

Input

Evidence of local arrangements to ensure newborn resuscitation is initiated without delay in the newborn not breathing spontaneously at birth

– Availability of updated policy, procedure or guidelines consistent with WHO guidelines in the delivery areas of maternity services

Proportion of health facilities with functional bags and masks (two neonatal mask sizes) in the delivery areas of maternity services, at all times and in sufficient quantities, consistent with the expected number of deliveries

Proportion of health facilities with health workers with skills in basic newborn resuscitation, as demonstrated by positive pressure ventilation with bag and mask simulated on a manikin, present at all times, in sufficient quantities and consistent with the expected number of deliveries

Output: Proportion of all births that were resuscitated

Outcome: Early neonatal mortality in term babies without major congenital

Example: Draft standard for resuscitation

WHO Quality of Care Vision | 16 April 2015 15 |