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Taking Every Opportunity to Save Lives: The Role of Modern Quality Improvement in Enhancing Maternal, Newborn, and Child Health Programs. A Synthesis of USAID Health Care Improvement Project Field Experience.

Tawfik Y | Bongiovanni A | Vaid S | Hermida J | Boucar M | Hill K
Organization: USAID Health Care Improvement Project/URC

Topics: Active management of the third stage of labor, Antenatal care, Community case management of child illness, Essential newborn care, Essential obstetric care, Maternal, Newborn and Child Health, Neonatal sepsis/infection, Pneumonia case management, Scaling up, Service integration

Region and Country: Afghanistan, Guatemala, Honduras, Kenya, Mali, Nicaragua, Niger, Senegal, Uganda


Several quality gaps have been documented across the continuum of maternal, newborn, and child health (MNCH) services.   For antenatal care (ANC), despite the progress in increasing its coverage, quality gaps persist. Several studies show that ANC services often miss the opportunity to provide essential services such as counseling clients on danger signs of pregnancy, delivery plans, nutrition, and postpartum family planning. Similarly, services around childbirth are often provided with compromised quality. Common quality gaps include the inadequate or incorrect use of the partograph to prevent the complications of prolonged labor for the mother and the newborn, neglecting to apply active management of third stage of labor to prevent postpartum hemorrhage, poor quality of emergency obstetric care, and failure to promptly detect newborn asphyxia and apply immediate resuscitation.

Quality improvement (QI) offers a powerful a means to increase the effectiveness of MNCH programs in resource-limited countries. QI is based on the understanding that a system is designed to produce the results it produces; in order to obtain better results, the system must change. Hence, in applying QI, teams in health facilities or communities analyze the systems and processes of delivering services, test changes to obtain better results, and measure the effect of the tested changes on pre-determined indicators. Teamwork and shared learning between QI teams allow for rapid spread of best practices.

This paper discusses the role modern QI approaches can play in improving MNCH outcomes and describes specific applications of across the continuum of MNCH care, including ANC, essential obstetric and newborn care, infant and child care, and post-partum family planning.  Drawing on examples from the work of the USAID Health Care Improvement Project (HCI) in Africa, Asia, and Latin America, the paper shows how quality gaps in the services addressing the antenatal, intra partum, postnatal, neonatal, and child periods can be closed through modern QI approaches.

QI can be applied at all levels of the health system, using existing resources, to put in place long-lasting changes in how care is provided. The first step in any QI project is to engage with national policymakers to understand their priorities and strategies. At the individual sites, process deficiencies and their associated outputs are quantified and the inner mechanisms responsible for those deficiencies, exposed. Specific barriers to implementation of effective processes are addressed with the in-depth knowledge and innovative capacity of individuals who work in those processes on a daily basis. Solutions are created by the owners of the problems who are best positioned to design and implement interventions to close the gaps in health service quality. Quality improvement uses continuous monitoring of processes to understand the effect changes have on health outcomes. When the data show that a change in the process produced an improvement, this learning is then shared with colleagues to spread the idea across facilities, districts, and regions.