Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: Bangladesh has achieved MDG4 and is on track to achieve MDG5. ; post-neonatal mortality declined by 78% between 1990 and 2014, however the reduction in neonatal mortality has not been as satisfactory (46%). To further accelerate the rate of reduction in maternal and neonatal mortality, the Government of Bangladesh with support from UNICEF has implemented the TQM initiative (5S-CQI-TQM) to improve both clinical and management aspect. The aim of this study was to assess whether the quality improvement model led to improved quality of care and clinical outcomes in selected facilities.
Methodology: Eleven referral facilities were selected for implementation of 5S-CQI-TQM during January 2013 to June 2014.Quantitative and qualitative methods were applied for evaluation and included baseline assessment, continuous monitoring, process documentation and an end-line assessment. Quantitative data collection tools were structured questionnaires for healthcare seeker, service providers, facilities, and bi-monthly monitoring checklist. In-depth interviews were conducted with hospital managers and service providers.
Results: The composite scores for management of neonatal asphyxia, low birth weight and sepsis were improved from 39%, 52% and 65% at baseline to 89%, 82% and 87% respectively at endline. The In-hospital neonatal mortality rate was reduced from 8.3% to 5.6%. Substantial improvement was reported for provision of ANC and PNC in most of the facilities. The qualitative findings identified that the strengths of this approach are based on strong leadership with team participation while major challenges exist around shortage of human resources and work load.
Conclusion: TQM is a long-term continuous process which requires changes in every sphere of a facility. Long-term area-specific interventions including mentoring, task shifting, identification of skill needs and training, logistics supply and incentives for service providers are crucial for ensuring TQM.