Improving the Quality of Maternal and Newborn Health in Low-Resource Settings: Lessons From the Saving Mothers, Giving Life Program
For maternal and child health advocates, witnessing the declines in maternal and newborn mortality over the past 25 years—especially the accelerated reductions during the last decade—has been encouraging. However, the reality that these largely preventable deaths continue to occur primarily in low-resource settings should heighten our resolve to end this egregious global public health inequity.
As we work to meet the Sustainable Development Goals and achieve equity in care, the global health community realizes the need to increase efforts to ensure access to quality maternity services. Expanding access means improving care wherever women seek it, whether from a physician in an urban government hospital or from an independent midwife operating her own clinic in a rural village. It also necessitates addressing the structural and process-related aspects of quality, including the woman’s experience of care.
We can draw some valuable lessons on quality care from our experience over the past three years with Saving Mothers, Giving Life (SMGL). This public-private partnership has produced impressive improvements in maternal health in sub-Saharan Africa by addressing all three of the delays to receiving quality care: seeking appropriate care; accessing care in a timely manner; and receiving high quality, woman-centered care.
The 2016 Annual Report, based on 2015 data, highlights results from SMGL’s comprehensive systems approach:
- In Zambia, the maternal mortality ratio in health facilities decreased by 55% in the original six SMGL learning districts.
- In Uganda, the maternal mortality ratio declined by 44% in both facilities and communities in the four original learning districts.
- Both countries are currently on track to meet SMGL’s ambitious goal of halving the maternal mortality ratio in the target districts by 2017.
These successes are the result of strategic investments that have not only increased the facility delivery rate in both countries, but have also improved the care a woman receives while giving birth at that facility. One critical step is to routinely measure quality. SMGL measures the cesarean section rate trends, the number of women tested for HIV and newborns receiving HIV prevention medication, the status of the case fatality rate, among other indicators.
The results indicate that the quality of care that facilities are providing now is much better than before the start of the SMGL partnership. Both the local and national governments in Uganda and Zambia are proud of what has been accomplished so far and, as SMGL transitions to full country ownership, they have committed to sustaining this improved level of quality, scaling up the SMGL model to new districts.
While the early years of SMGL produced dramatic improvements in maternal health outcomes, comparable changes in newborn health have remained elusive. The teams on the ground are intensifying quality improvement efforts to strengthen healthcare providers’ ability to care for underweight and unhealthy newborns. There is now greater emphasis on training and mentoring related to caring for sick newborns to ensure all providers are equipped to save newborn lives. For example, home visiting programs are expanding to reach more women and newborns during the critical first three days of life. We are starting to see results from these efforts in Zambia where the perinatal mortality rate has decreased by 44%.
The SMGL partnership formally ends in Uganda and Zambia in December 2017. During this final year, there will be a robust evaluation to measure timely availability of quality services as well as other important indicators including changes in behavior; care-seeking; provider and client satisfaction; health system readiness and performance; and, of course, health outcomes. In Nigeria, SMGL is initiating operations in Cross River State, a region with disproportionately high rates of maternal mortality.
The efforts of our many partners—the U.S. Government, the Governments of Nigeria, Norway, Uganda and Zambia, Merck for Mothers, Every Mother Counts, Project C.U.R.E. and the American College of Obstetricians and Gynecologists—will be crucial to our continued success.
Over the next 15 months, ensuring and sustaining high quality care will be our top priority.
Check out other posts in the MHTF’s Quality of Maternal Health Care blog series.
Learn more about the issues surrounding quality of maternal health care.