This resource is focused on the quality of services, rather than quality of care which usually refers to the specific care provided by a health worker to a patient.
However, ensuring high standards of care and safety is an important consideration for many programmes. Organisations such as WHO, the UK’s National Institute for Health and Care Excellence (NICE) and professional organisations such as the UK’s Royal College of Obstetrician and Gynaecologists (RCOG) publish guidelines and recommendations for quality of care. The Partnership for Maternal, Newborn and Child Health has developed a factsheet on assuring the quality of care.
A number of frameworks have also been developed to help evaluate the quality of care provided (see Hulton et al 2000). In the case of the UK NICE standards indicators have been developed for the broader patient experience, such as respectful care, shared decision making and adequate communications, as well as clinical care. Although not universal, many countries have developed national standards and processes for monitoring, supervising and/or auditing the quality of care provided and some have undertaken other measures to institutionalise the quality of care provided; for example through revising pre-service and in-service education and training.
Safety is a relatively new concept of quality and underscores the need to ensure that any negative effects of services are considered in addition to efficiency, effectiveness and acceptability. (See the 2010 British Medical Journal special edition on quality and safety for more information).
The consideration of safety usually involves balancing opposing hazards and benefits. For example, a health systems perspective would consider the implications of health promotion messages that encourage more women to deliver in health facilities. If the risk of introducing an infection is high during delivery in a health facility, encouraging women to deliver in health facilities may expose them to further dangers. This analysis would also depend on an understanding of the conditions and the care women receive when delivering at home.
Safety also includes non-clinical aspects, for example, services should help pregnant mothers feel secure and not exposed to physical or verbal abuse, or hazardous facilities (e.g. unclean or physically dangerous environments).
The following box describes a specific safety issue associated with treatment during pregnancy.
There have been a number of attempts to define indicators to measure the clinical quality of MNH care. These include:
- A WHO consultation on a proposed 19 global indicators for improving the measurement of the quality of maternal, newborn and child care in health facilities (WHO 2013).
- The Initiative for Maternal Mortality Programme Assessment (IMMPACT) TRACE programme which uses confidential enquiry techniques to investigate adverse events and to assess the quality of care provided (see IMMPACT 2007).
- USAID funded CORE, Maternal and Newborn Standards and Indicators Compendium which offers a comprehensive breakdown of indicators across the continuum of care.
- Dashboard approaches of key performance indicators (see Sprague et al 2013).
- Some common challenges include the availability of complete and accurate records, poor capacity to collate and analyse data, poor ownership and leadership of the issue and engagement by stakeholders.
- Hulton, LA. Matthews, Z. Stones, RW., (2000) A framework for the evaluation of quality of care in maternity services
- BMJ, (2010) BMJ Quality & Safety
- Ann E. Sprague, RN, PhD, Sandra I. Dunn, RN, PhD, Deshayne B. Fell, MSc, JoAnn Harrold, MD, FRCPC, Mark C. Walker, MD, FRCSC, Sherrie Kelly, MSc, Graeme N. Smith, MD, PhD, FRCSC; J Obstet Gynaecol Can; 35(1):29–38, (2013) Measuring Quality in Maternal-Newborn Care: Developing a Clinical Dashboard
- National Institute for Health and Care Excellence, (Website) Quality statement 2: Maternal health – life-threatening conditions
- Royal College of Obstetricians and Gynaecologists, (Website) Guidelines & research services
- World Health Organization (WHO), (2010) Assure Quality Care
- World Health Organization and Partnership for Maternal, Newborn and Child Health, (2013) Consultation on Improving measurement of the quality of maternal, newborn and child care in health facilities
- The Initiative for Maternal Mortality Programme Assessment (IMMPACT), (2007) Tracing adverse and favourable events in pregnancy care (TRACE)
- Safe Motherhood and Reproductive Health Working Group, CORE Group., (2004) Maternal and Newborn Standards and Indicators Compendium