Comparison of the implementation of the extreme maternal morbidity surveillance model in 12 health institutions in Colombia, 2013. Mixed study: Qualitative and quantitative

Abstract

Objective: To compare the level of implementation of the Extreme Maternal Morbidity Surveillance Model (EMMSM). and the main barriers and facilitators to the implementation in two groups of Healthcare Service Providers (HSP) in Colombia. Materials and methods: Mixed study using quantitative (semi-structured tool) and qualitative (In-depth interview) information techniques. The healthcare service providers in which the pilot model was implemented (pHSP) were compared with another group of healthcare institutions that did not participate in the initial implementation, hereinafter called control HSP (cHSP). They were are all selected jointly with the Ministry of Health (MoH) based on convenience. The level of implementation is presented in terms of proportions for each healthcare institution. The information was crossed-referenced in order to supplement the data of the various components of the EMMSM implementation. Results: Differences in implementation were found for each IPS group. In the IPSP there was greater dissemination of the protocols, detection, notification, information flows and decision-making. In the IPSC group there were more difficulties in determining main causes, defining avoidability criteria, and identifying delays. The numbers of professional staff, mean monthly hours and profiles were higher among the IPSP when compared with the IPSC. The level of implementation among the healthcare providers in the IPSP group ranged between 73 % and 94 %, and between 41 % and 90 % in the IPSC group. There was greater clarity among the IPSP regarding the role of the MVMME as a tool for quality improvement in care provided to pregnant women. Among the IPSC, although the model was considered a means to improve quality, it was perceived as work overload. Conclusions: The higher degree of development among the IPSP may be associated with a higher level of support from the MOH and the United Nations Fund for Population Activities (UNPFA), and greater political and institutional support for the implementation.