The average proportion of women in developing countries with skilled attendance at birth increased from 56% in 1990 to 68% in 2012. While skilled birth attendance is one factor affecting health outcomes for mothers and newborns, gaps in quality of care have been identified as contributing causes of maternal and newborn mortality and morbidity in numerous countries. In its groundbreaking publication, Crossing the Quality Chasm, the Institute of Medicine proposed that high quality health care should be safe, effective, patient-centered, timely, efficient and equitable. Defining characteristics are not sufficient for identifying gaps in quality of care; specific, operationalized measures that can be used by health care workers in diverse settings are crucial for improving quality of care.
To combat preventable perinatal morbidity and mortality, WHO recently published a framework for measuring and improving quality of maternal and newborn health care in facilities across the globe. The framework summarized below includes eight standards of high quality care and a comprehensive list of measures to identify quality gaps throughout the continuum of care for women and newborns:
Standard 1: Evidence-based practices for routine care and management of complications
- Timely, routine assessment of mother during labor and delivery
- Routine postnatal care for mothers and newborns
- Appropriate, timely treatment for pre-eclampsia/eclampsia and postpartum hemorrhage
- Appropriate interventions for obstructed or delayed labor
- Immediate stimulation and resuscitation of newborns unable to breathe on their own
- Appropriate interventions for mother and baby in cases of preterm delivery
- Appropriate, timely interventions for women and newborns to prevent infections
- No unnecessary or harmful practices for women or newborns
Standard 2: Actionable information systems
- Complete, accurate, standardized medical records
- Mechanism for data collection, analysis and feedback at every hospital
Standard 3: Functional referral systems
- Timely assessments upon admission, during labor and during the early postnatal period to determine whether referral is required
- Referrals follow a pre-established plan and can be implemented without delay
- Appropriate exchange of information and feedback between health facilities in case of referral
Standard 4: Effective communication
- Information about care is shared with women and their families
- Effective interactions between women and their families and health care staff
- Coordinated care among relevant health and social care professionals
Standard 5: Respect and preservation of dignity
- Privacy and confidentiality during labor and delivery
- No disrespect, abuse, discrimination, neglect or other maltreatment of women or newborns
- Women can make informed decisions about their care
Standard 6: Emotional support
- Women can choose to have a companion of their choice present for labor and delivery
- Women receive support to strengthen capability during delivery
Standard 7: Competent, motivated human resources
- Constant access to at least one skilled birth attendant and support staff for mothers and babies
- Skilled birth attendants and support staff have appropriate competencies and skills
- Accountability of managerial and clinical leadership for creating and implementing appropriate policies and a supportive environment for staff
Standard 8: Essential physical resources available
- Functioning, reliable and safe facilities for water, energy, sanitation, hand hygiene and waste disposal
- Appropriate design, organization and maintenance of physical infrastructure
- Adequate stocks of medicines, supplies and equipment
The comprehensive framework provides clinicians and public health professionals with a guided path toward accurately identifying gaps in quality of maternal and newborn care in facilities around the world. Hopefully its use will facilitate the development of effective interventions that ultimately save mothers’ and babies’ lives. How can facilities in low-resource settings develop the capacity and infrastructure necessary to implement these new WHO standards?
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Read the full WHO report for a complete list of measures for each quality standard.
Learn more about quality of maternal health care.