Case Study: Experience Applying and Tracking a Quality Improvement Approach for Maternal and Newborn Health Services in Sub-Saharan Africa

Abstract

Background Many low-and middle-income countries did not achieve the Millennium Development Goal targets for reductions in maternal and child mortality (United Nations 2015), despite notable increases in utilization of maternal and newborn health (MNH) ser-vices. A focus on increasing attendance at facility-based MNH services, at the expense of quality, contributed to the problem (Austin et al. 2014; Srivastava et al. 2014). Quality improvement initiatives play a crit-ical role in guiding how services are pro-vided so that they can have the intended impact on morbidity and mortality. However, there is a lack of global evidence regarding the benefits of quality improve-ment initiatives, in part because routine data needed to monitor progress are miss-ing or unreliable (Bhutta et al. 2014; Bradley and Yuan 2012). Quality improvement was one focus of the Maternal and Child Health Integrated Program (MCHIP), a global program of the United States Agency for International Development (USAID) that supported the introduction and scale-up of high-impact maternal, newborn and child health interven-tions. From 2008 to 2013, MCHIP worked with Ministries of Health to apply the Standards-Based Management and Recognition (SBM-R®) quality improvement approach to a range of health service areas in 16 countries. This case study describes the experience of four countries that applied SBM-R to MNH services (Guinea, Mozambique, Nigeria and Zimbabwe) and the results of their efforts. Intervention SBM-R is a practical approach to quality improvement that empowers providers and managers to take the initiative to improve the quality of services in their facility. Each of the case study countries applied the SBM-R approach following a four-step process that incorporates a continuous " Plan, Do, Study, Act " (PDSA) cycle (Necochea and Bossemeyer 2005; Necochea et al. 2015; Tawfik et al. 2010): 1: Set standards. Detailed, evidence-based standards for the organization and functioning of MNH services were established based on international and national evidence-based norms, policies and guidelines. These standards defined desired provider performance and specified tasks essential to good quality care. The standards also formed the basis for an SBM-R MNH assess-ment tool for use at the facility level.