Using a quality improvement model to enhance providers' performance in maternal and newborn health care: A post-only intervention and comparison design

Firew Ayalew*, Gizachew Eyassu, Negash Seyoum, Jos van Roosmalen, Eva Bazant, Young Mi Kim, Alemnesh Tekleberhan, Hannah Gibson, Ephrem Daniel, Jelle Stekelenburg

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: The Standards Based Management and Recognition (SBM-R©) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. Methods: A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. Results: There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother. Conclusions: The SBM-R quality improvement intervention made a significant positive impact on MNH providers' performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government's five-year (2015-2020) health sector transformation plan and health care quality strategies needed to meet the country's MNH goals.

Original languageEnglish
Article number115
Pages (from-to)1-9
Number of pages9
JournalBMC Pregnancy and Childbirth
Volume17
Issue number1
DOIs
Publication statusPublished - 12 Apr 2017

Funding

This study was made possible by the generous support of USAID under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00 of the Maternal and Child Health Integrated Program (MCHIP). The contents are the responsibility of Jhpiego and do not necessarily reflect the views of USAID or the United States Government. USAID did not have any additional role in the study design, data collection and analysis, interpretation of the data, or preparation of the manuscript. Study participants did not receive financial incentives for their participation in the study. We acknowledge the Federal Ministry of Health of Ethiopia for giving permission to conduct the study and the United States Agency for International Development (USAID) for providing financial support. We are also grateful to Professor Judith T. Fullerton and Adrienne Kols for their critical reviews of the manuscript and Dr. Diwakar Mohan for providing guidance in data analysis. Finally, we would like to acknowledge the study participants, the data collectors and supervisors.

FundersFunder number
Federal Ministry of Health of Ethiopia
Maternal and Child Health Integrated Program
United States Agency for International DevelopmentGHS-A-00-08-00002-00

    Keywords

    • Antenatal care
    • Ethiopia
    • Labor and delivery
    • Maternal health
    • Newborn health
    • Postnatal care
    • Provider performance
    • Quality improvement
    • SBM-R

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