QAP conducted a four-country operations research study that examined determinants of skilled attendance of birth and the quality of maternal care. Data were collected in Benin, Ecuador, Jamaica, and Rwanda in three areas: 1) measuring competency of skilled birth attendants; 2) in-facility delays occurring during labor, delivery, and postpartum care that contribute to maternal complications and poor outcomes; and 3) factors other than competency that affect the quality of maternal care and immediate newborn care. Findings were presented at the White Ribbon Conference in India in October 2002 and at the PAHO regional consultation on skilled attendance at birth in Bolivia in June 2003. See studies described in Operations Research Safe Motherhood.
Under the LAC Maternal Mortality Reduction Initiative, QAP is working with PAHO and Ministries of Health in Ecuador, Honduras, Nicaragua, and Peru to implement the first international improvement collaborative on essential obstetric care. Teams in each of the four countries are implementing integrated EOC systems in at least one province, with an eye toward eventual scale-up of the improvements to the entire national health system.
As part of the institutionalization of QA in Nicaragua, teams are conducting quality assessments in labor and delivery, obstetric surgery, and neonatal care and implementing quality improvement interventions to assure safe delivery in eight of the country's 17 SILAIS.
In Ecuador, QAP is supporting the introduction of continuous quality improvement methods as part of the national scale-up of the Free Maternity Program, which guarantees access to selected maternal and child health interventions.
QAP is developing follow-up research to the four-country Maternal Health Study to further test and validate the instruments used to measure the competency of birth attendants and to develop lower-cost instruments and data collection methods to assess the quality of labor, delivery, and postpartum care.
Related QAP Publications:
- Kenya: Assessment of Health Workforce Competency and Facility Readiness to Provide Quality Maternal Health Services
- Comparison of Two Methods for Determining Provider Attendance during Normal Labor and Delivery: Benin, Ecuador, Jamaica, and Rwanda
- Safe Motherhood Studies—Timeliness of In-Hospital Care for Treating Obstetric Emergencies: Results from Benin, Ecuador, Jamaica, and Rwanda
- Quality of Obstetric Care Observed in 14 Hospitals in Benin, Ecuador, Jamaica, and Rwanda
- Baseline Assessments of Essential Obstetric Care: Bolivia, Ecuador, and Honduras (Report)
- Designing Quality Essential Obstetric Care Services in Honduras (Case Study)
- Designing Obstetric Services to Reduce Maternal Mortality in Guatemala (Case Study)
- Developing Evidence-Based Standards for Pregnancy Standards Induced Hypertension in Russia (Case Study)
- Estudios de maternidad segura—Resultados del Ecuador
- Improving Compliance with Standards for Essential Obstetric Care in Bolivia (Case Study)
- Improving Care for Women Suffering from Pregnancy-Induced Hypertension (Report)
- Improving the Quality of Care for Women with Pregnancy-Induced Hypertension Reduces Costs in Tver, Russia (Operations Research Manual [ORM])
- Quantifying the Economic Impact of Using Evidence-Based Clinical Guidelines for Pregnancy Induced Hypertension in Two Hospitals in Tver Oblast (Report)
- Redesigning Hospital Documentation Systems to Improve the Quality of Patient Obstetric Records in Ecuador (ORM)
- Safe Motherhood StudiesResults from Benin: Competency of Skilled Birth Attendants, The Enabling Environment for Skilled Attendance at Delivery, In-Hospital Delays in Obstetric Care (Documenting the Third Delay)
- Safe Motherhood Studies—Results from Jamaica: Competency of Skilled Birth Attendants; The Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)
- Safe Motherhood Studies—Results from Rwanda: Competency of Skilled Birth Attendants; The Enabling Environment for Skilled Attendance at Delivery; In-Hospital Delays in Obstetric Care (Documenting the Third Delay)
- Using Quality Assessment to Improve Maternal Care in Nicaragua (Case Study)