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transcript
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Routine Measurement of Quality of CareBarbara Rawlins
Senior Monitoring and Evaluation Manager,MCHIP/Jhpiego
Maryjane LacosteTanzania Country Director/MAISHA Program Director, Jhpiego
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Presentation Overview
Review existing routine quality of care measurement methods
Describe gaps in routine quality of care data for maternal and newborn health services
Present a case study from Tanzania Discuss future measurement plans
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Measuring the Quality of Maternal and Newborn Care is…
Multi-faceted and complex Especially measurement of quality of
intra-partum care (as it includes both routine care and management of complications)
Usually conducted through both periodic surveys and routine measurement mechanisms
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Why measure the quality of maternal and newborn care routinely?
Program managers and policy makers need regular and reliable data for decision making: Need to understand how the health system is
performing at multiple levels Need to know if “skilled birth attendants” are
really skilled Need to determine if facilities are “ready” to
provide services with respect to infrastructure, supplies, drugs and equipment
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Key Methods for Measuring MNH Quality of Care Routinely
1. Structured clinical observation of provider-client interactions Data sources: clinical checklists applied by peers and/or
external assessors (e.g., checklists used for quality improvement initiatives, supervision checklists)
Data captured: compliance with clinical guidelines and standards
2. Inventory of facility infrastructure/supplies/equipment Data sources: facility audit checklists, supervision reports Data captured: Stockouts of key medicines, broken and
absent equipment, organization of services
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Key Methods for Measuring MNH Quality of Care Routinely (2)
3. Record review Data sources: Health management information
system (HMIS) reports; facility registers; patient charts; criterion-based audits; near miss audits; maternal and perinatal death audits; sentinel site surveillance systems, logistics management information systems
Data captured: service utilization; frequency of provision of evidence-based components of care (e.g., for ANC– iron, TT, IPTp); management of complications; numbers of deaths and complications
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Many Gaps in Routine MNH Quality of Care Data
Observational assessments of client-provider interactions are not widely conducted on a routine basis
Logistics management information systems and supervision reports only include a limited set of facility readiness indicators, such as stockouts
Many MNH service indicators of interest are not captured in national HMIS, especially those related to intrapartum care (e.g., active management of the third stage of labor)
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Adapting Sentinel Site Surveillance for MNH Quality of Care Monitoring
MCHIP/Malawi and the MAISHA Program in Tanzania are in the process of applying a sentinel site surveillance approach for the continuous quality monitoring of MNH services
The MNH SSS systems are intended to: Complement MNH data available from national HMIS
reports Test the feasibility of collecting additional MNH quality
indicators at facilities on a routine basis Generate national support for routine collection of
facility-based quality indicators that prove feasible
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
What is sentinel site surveillance?
Sentinel sites are health facilities selected (using specific criteria) for monitoring of key indicators that are generally not reported up through the national health management information system
Sentinel site surveillance (SSS) traditionally has been used to track disease-related indicators: National Malaria Control Programs and the U.S.
President’s Malaria Initiative (PMI) use SSS to monitor trends in inpatient and outpatient malaria cases, inpatients deaths, uptake of intermittent preventive treatment of malaria by antenatal care clients
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Tanzania Case Study: MNH Quality Monitoring by the MAISHA Program
The ACCESS/Tanzania program initiated a SSS system for FANC in 2006/7 A total of 30 facilities across 16 regions were selected:
10 midwifery preservice clinical sites (hospitals) and 20 facilities that received FANC inservice training (hospitals, health centers and dispensaries)
The SSS System was expanded under MAISHA in 2009 to include monitoring of essential and emergency obstetric and newborn indicators Now have 40 facilities across 21 regions plus Zanzibar:
19 hospitals, 12 health centers, 9 dispensaries
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Tanzania Case Study: SSS Indicators
FANC Indicators % of ANC clients receiving
IPTp1 and IPT2 % of ANC clients tested for
syphilis % of ANC clients treated for
hookworm Number of ANC clients with
Hb < 8.5g/dl Number of functional BP
machines with stethoscope Number of days SP, RPR
kits and iron out of stock
EONC/EmONC Indicators Number of women with
obstetric complications (by type of complication) and number referred
Number of maternal deaths by cause
Number of newborn deaths (<24 hours, 24hours+)
Number of stillbirths Number of days oxytocin,
ergometrine, misoprostol and MgSO4 out of stock
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Tanzania Case Study: FANC Trends
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Tanzania Case Study: EMOC Drug Stockout Trends
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
On the Horizon for MCHIP and MAISHA
MAISHA in Tanzania plans to expand data collection to 200+ facilities from all districts
MCHIP/Malawi is testing a routine MNH Quality sentinel surveillance system in the coming months
MCHIP plans to explore how an abbreviated version of the MNH Quality of Care facility survey can be applied on a routine basis
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
A discussion question for you…
Are there aspects of MNH quality of care we could be monitoring but we are not?
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011
Thank you!
Follow MCHIP on:www.mchip.net
MNH Quality of Care Measurement Resources:
http://www.who.int/reproductivehealth/publications/monitoring/9789241547734/en/index.htm
http://www.rollbackmalaria.org/partnership/wg/wg_pregnancy/docs/MIPMEFramework.pdf