Quality of Care Introduction
Delivering quality MNCH services
Improving health care delivery demands a deliberate focus on quality, including effective, safe, people-centered care that is timely, equitable, integrated, and efficient. The 2019 United Nations General Assembly's resolution on Universal Health Coverage underscored the urgent need for quality care. Evidence indicates that quality care can prevent death and disability, with high-quality health systems potentially averting half of all maternal and newborn deaths, according to the 2018 Lancet Commission report.
Achieving quality care requires effort across all levels – national, district, and health facility. The performance and outcomes of health systems depend on the involvement of all stakeholders.
What Are the Benefits of Delivering Quality MNCH Care?
Global evidence indicates that improving the quality of maternal, newborn, and child health (MNCH) service delivery can significantly reduce mortality and morbidity. According to a study published in PLOS Medicine, addressing the quality of care in low- and middle-income countries could lead to a 28% decrease in maternal deaths, a 28% decrease in neonatal deaths, and a 22% reduction in stillbirths[1]. Additionally, high-quality health systems could prevent an estimated half of all maternal and newborn deaths[2].
[1] Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study | PLOS Medicine
[2] Maternal, Newborn, Child and Adolescent Health and Aging Department
In addition to facilitating the LGs in contributing to the reduction of national and state / provincial targets of reducing maternal, newborn, and child mortality; improving the quality of health service delivery at the primary healthcare level leads to:
Access to Skilled Care
Ensuring that births are attended by skilled health professionals can significantly reduce complications during childbirth and improve outcomes for both mothers and newborns.
Timely Emergency Care
Establishing efficient emergency referral systems ensures that patients with complications can quickly access higher-level care, reducing the risk of mortality and morbidity.
Continuity of Care
Providing comprehensive antenatal and postnatal care helps monitor the health of mothers and babies, identify potential risks, and provide timely interventions.
Family Planning Services
Access to family planning services helps women space pregnancies and avoid unintended pregnancies, reducing the risk of maternal and newborn complications.
Nutrition Programs
Implementing nutrition programs that focus on maternal and child nutrition can improve health outcomes and reduce the risk of malnutrition-related complications.
Community Engagement
Involving communities in health promotion activities and education programs increases awareness and demand for quality MNCH services, leading to better health-seeking behaviors.
Quality Improvement Initiatives
Establishing quality improvement teams within primary healthcare facilities to monitor and improve service delivery can lead to better outcomes.
Respectful and Dignified Care
Ensuring that healthcare providers deliver respectful and dignified care improves the experience and outcomes for women and families.
How to Implement
WHO provides a comprehensive framework for implementation and improvement of quality of care in health service delivery.
1. Assess and Plan
- Conduct a situational analysis to identify service delivery gaps and areas needing quality improvement.
- Develop a quality improvement (QI) plan with specific goals, targets, and timelines based on the analysis.
2. Build Capacity
- Train healthcare workers and staff on QI methods, MNCH protocols, and evidence-based practices.
- Strengthen local government (LG) leaders’ and managers’ ability to support and sustain QI initiatives.
3. Implement Interventions
- Introduce evidence-based clinical guidelines, protocols, and standards (e.g., from WHO or national frameworks).
- Ensure health facilities are equipped with the necessary medicines, supplies, and equipment to deliver quality care.
4. Monitor and Evaluate
- Establish or strengthen systems for regular monitoring and evaluation by LG leadership.
- Use existing review forums and tools to track key indicators and identify areas for improvement.
5. Engage Communities
- Strengthen or establish community-facility linkages (e.g., village health committees).
- Involve community members in planning and implementing QI activities and promote health awareness campaigns.
6. Provide Supportive Supervision
- LGs should mobilize technical experts to provide regular, supportive supervision to healthcare providers.
- Offer on-the-job coaching, feedback, and troubleshooting to uphold quality standards.
7. Promote Learning and Adaptation
- Encourage a culture of continuous improvement within health facilities and LG units.
- Share best practices, success stories, and lessons learned to enhance future QI activities.
8. Strengthen Policy and Governance
- Advocate for policies and governance structures that institutionalize quality improvement at all levels.
- Align local QI efforts with national health strategies for consistency and long-term sustainability.
What's the Evidence
Improving the quality of healthcare at the primary healthcare level has been shown to significantly enhance health outcomes for mothers, newborns, and children. Here are some key pieces of evidence:
- WHO's Point of Care Quality Improvement (POCQI) Manual: This manual highlights that quality improvement interventions at the primary healthcare level can lead to better health outcomes for mothers and newborns. The manual provides a framework for implementing quality improvement initiatives in health facilities, emphasizing the importance of continuous monitoring and evaluation.
- BMJ Global Health Study: A study published in BMJ Global Health reviewed quality improvement interventions in maternal and newborn healthcare across several countries. The findings indicate that capacity-building, governance, systemic quality improvement at the facility level, and community support are effective in improving health outcomes.
- BMC Health Services Research: A study conducted in Ethiopia demonstrated that quality improvement interventions at the primary healthcare level led to significant improvements in maternal and newborn health outcomes. The study found increased rates of syphilis testing, better adherence to safe childbirth practices, and improved service delivery.
Key Indicators
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Tips
- Developing LGs’ leadership buy-in for quality service delivery of MNCH is the key to sustainable improvement in maternal, newborn, and child health outcomes.
- Continuous and systematic coaching, using the TCI coaching model on MNCH quality protocols, is essential for making quality of care a second nature for healthcare providers.
- Focus on data management – recording, completion, validation – and data-centric decision making is critical for improving the quality of health service delivery.
- Robust monitoring, evaluation, and feedback regarding MNCH quality of care serve as the backbone of improved quality health service delivery and health outcomes.
Challenges
- Limited Resources: Inadequate financial, human, and material resources can hinder the implementation of quality MNCH interventions. Local governments should advocate for increased funding, allocate adequate resources, and strengthen partnerships with international organizations, NGOs, and the private sector to mobilize additional support.
- Training and Capacity Building: Many healthcare providers lack sufficient training in MNCH quality service delivery, leading to critical gaps in care. Local governments should strengthen staff training programs through needs assessments, continuous in-service training, e-learning platforms, mentorship, and regular supportive supervision.
- Infrastructure and Equipment: Poor facility infrastructure and a lack of essential medical equipment compromise the delivery of quality care. Local governments should invest in upgrading health facilities, ensure the consistent availability of necessary supplies, and implement routine maintenance and inventory systems.
- Data Collection and Monitoring: Weak data systems and poor monitoring limit the ability to evaluate and improve service quality. Local governments should enhance data systems, build provider capacity in data management, integrate QOC indicators into performance reviews, and use data regularly for decision-making and quality improvement.
Key Resources
- Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries. PLOS Med 2019
- Maternal, Newborn, Child and Adolescent Health and Aging Department. WHO
- Successes and challenges towards improving quality of primary health care services: a scoping review. BMC Health Services Research 2023
- Fact sheet: Quality health services. WHO 2020
- Improving quality of care for maternal, newborn and child health - Implementation Guidance. WHO 2017
- Quality of Care Learning Hub. WHO
