Accountability for quality of care : monitoring all aspects of quality across a framework adapted for action

Quality of care is essential to maternal and newborn survival. The multidimensional nature of quality of care means that frameworks are useful for capturing it. The present paper proposes an adaptation to a widely used quality of care framework for maternity services. The framework subdivides quality into two inter-related dimensions—provision and experience of care—but suggests adaptations to reflect changes in the concept of quality over the past 15 years. The application of the updated framework is presented in a case study, which uses it to measure and inform quality improvements in northern Nigeria across the reproductive, maternal, newborn, and child health continuum of care. Data from 231 sampled basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) facilities in six northern Nigerian states showed that only 35%–47% of facilities met minimum quality standards in infrastructure. Standards for human resources performed better with 49%–73% reaching minimum standards. A framework like this could form the basis for a certification scheme. Certification offers a practical and concrete opportunity to drive quality standards up and reward good performance. It also offers a mechanism to strengthen accountability.PostprintPeer reviewe

Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

AbstractAccountability mechanisms help governments and development partners fulfill the promises and commitments they make to global initiatives such as the Millennium Development Goals and the Global Strategy on Women’s and Children’s health, and regional or national strategies such as the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA). But without directed pressure, comparative data and tools to provide insight into successes, failures, and overall results, accountability fails. The analysis of accountability mechanisms in five countries supported by the Evidence for Action program shows that accountability is most effective when it is connected across global and national levels; civil society has a central and independent role; proactive, immediate and targeted implementation mechanisms are funded from the start; advocacy for accountability is combined with local outreach activities such as blood drives; local and national champions (Presidents, First Ladies, Ministers) help draw public attention to government performance; scorecards are developed to provide insight into performance and highlight necessary improvements; and politicians at subnational level are supported by national leaders to effect change. Under the Sustainable Development Goals, accountability and advocacy supported by global and regional intergovernmental organizations, constantly monitored and with commensurate retribution for nonperformance will remain essential

A framework for assessing quality of maternal health services and preliminary findings from its application in Urban India

This paper introduces a framework for assessing the quality of care of institutional maternity services developed by researchers at the University of Southampton. The framework divides quality into two parts: the quality of the provision of care and the quality of users’ experience of care. Preliminary findings from the application of this framework within a slum area of Mumbai are presented. Data from municipal and private hospitals were collected using a community survey of 650 women, observation, exit interviews, provider interviews, review of hospital records, and the mystery client approach. Findings provide evidence that quality is far from optimal in both municipal and private facilities. Quality issues identified include a lack of essential drugs, the use of inappropriate procedures that are not evidence-based, users being left unsupported, evidence of physical and verbal abuse and institutional delivery which does not guarantee attendance by a health professional. There is also evidence that the quality of experience of care varies significantly by background characteristics of the woman and her family

Quality of care in maternity services : childbirth among the urban poor of Mumbai, India

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Quality of care in maternity services : childbirth among the urban poor of Mumbai, India

The framework draws together experience and evidence from the extensive medical, health policy and social science literature on all aspects of quality in maternity care to create a flexible quality assessment framework specifically for use at the institutional level in developing countries.  It divides quality into two elements:  firstly into the provision of quality of care, and second into elements relating to users’ experience of that care.  These two important aspects of quality of care in pregnancy and childbirth are intrinsic components of a basic reproductive rights approach.  The framework is then applied to practice to evaluate the quality of the provision of care and the quality of the experience of care at maternity institutions in a slum area of the eastern suburbs of Mumbai, India’s most populous city.  The city has one of the highest institutional delivery rates for the country as a whole with 82% of women living in slums delivering in an institution. The findings provide evidence that quality is far from optimal in both municipal and private facilitates.  Within elements of the quality of the provision of care issues ranged from lack of essential drugs to the use of inappropriate procedures that are not evidence-based.  Within elements of the quality of the experience of care issues ranged from users being left unsupported, evidence of physical and verbal abuse and institutional delivery which does not guarantee attendance by a health professional let alone skilled attendance.  There is no substantive difference in the quality of care (beyond the quality of the provision of human and physical resources) that women receive and experience at private providers, indeed they are at greater risk of unnecessary interventions.  Findings do show, however, that the quality of experience of care varies significantly by background characteristics of the woman and her family.</p

Das Humor-Verhalten der ROTE NASEN Clowndoctors bei hospitalisierten Säuglingen und Kleinkindern

Die Anwesenheit von Gesundheitsclowns in Krankenhäusern wächst zunehmend. Die positive Wirkung von Clowns auf die Patienten, die bereits von einigen Studien bestätigt wurde, lässt vor allem das Interesse in pädiatrischen Abteilungen steigen. Durch den Besuch der Clowns in den Krankenzimmern, kann die Angst vor bevorstehenden Operationen reduziert werden, die Kinder machen sich weniger Sorgen bezüglich ihres Krankenhausaufenthalts und weisen ein geringeres Stresslevel auf. Welches Verhalten die Clowns überhaupt anwenden, um diese Wirkungen erzielen zu können und inwiefern sie ihr Humor-Verhalten an das Alter der Kinder anpassen, wurde bislang nicht in den Fokus der Forschung gerückt. Die vorliegende Studie nahm es sich, mit Hilfe der ROTE NASEN Clowndoctors, zum Ziel, diesem Thema Aufmerksamkeit zu schenken. Die Untersuchung fand, im Zeitraum von 2.5 Monaten, an pädiatrischen Abteilungen des Donauspitals und Wilhelminenspitals statt. Dabei wurden die Clowns bei ihren Interaktionen mit 53 Säuglingen und Kleinkindern, im Alter von 2 bis 36 Monaten, beobachtet. Die Humor- Stimuli die während der Clown-Situation Anwendung fanden, wurden dafür in die 4 Reizkategorien: Auditiv, Visuell, Taktil und Sozial eingeteilt. Die Ergebnisse der Studie zeigten, dass die Gesundheitsclowns am häufigsten auditive und visuelle Stimuli verwendeten. Je jünger die Kinder waren, desto mehr auditive und taktile Reize wurden von den Clowns gezeigt. Die Gruppe der 2 bis 12 Monate alten Säuglinge erhielten signifikant mehr auditive Reize als die 24 bis 36 Monate alten Kinder, während die Altersgruppe 12 bis 24 Monate signifikant mehr visuelle Stimuli gezeigt bekam als die 2 bis 12-monatigen. Die Konstellation der Clownduos stellte dabei keinen Einfluss dar.The presence of health-clowns in hospitals is increasing rapidly. The positive effects of the clowns on the patients, which have been confirmed by many studies, especially increases the interest in pediatric divisions. With the visits of the clowns the fear of upcoming surgeries can be reduced, the children's worries about their hospitalization bear less heavy and the stress level decreases. The clowns' behavior to reach these effects and how they adapt their humorous actions to the children's age, has not been in the focus of scientific work. With the help of the ROTE NASEN Clowndoctors this study tries to fill this void. During 2.5 months of research in the pediatric divisions of the Donauspital and the Wilhelminenspital, 53 interactions between clowns and children (age 2 to 36 months) were observed. The humorous stimuli which were applied in the clown-child interaction were divided in 4 stimuli categories as follows: auditory, visual, tactile and social. The results of this study showed that health-clowns applied auditory and visual stimuli the most. The younger the children the more auditory and tactile stimuli were utilized by the clowns. The group of the 2 to 12 months old infants received significantly more auditory stimuli than the group of 24 to 36 months old children. However the group of 12 to 24 months old children received significantly more visual stimuli than the 2 to 12 months olds. The combination of the clown duos had no influence at all

Applying a framework for assessing the quality of maternal health services in urban India

This paper presents findings from the application of a framework for assessing the quality of care of institutional maternity services in an urban slum in India. The framework divides quality into two parts: the quality of users' experience of care and the quality of the provision of care. Data from public and private hospitals were collected via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women in the immediate vicinity of the case study hospitals. Findings provide evidence that quality is far from optimal in both public and private facilities. Problems identified included a lack of essential drugs, women being left unsupported, evidence of physical and verbal abuse, and births occurring in hospitals without a health professional in attendance. The paper concludes that while many governments have explicit targets to increase institutional deliveries, many do not have explicit targets or even a commitment to assess and improve the quality of institutional services for childbirth.India Quality of care Maternity services Quality framework Institutional childbirth/delivery Experience of care

Establishing a baseline to measure change in political will and the use of data for decision-making in maternal and newborn health in six African countries

The Evidence for Action (E4A) program assumes that both resource allocation and quality of care can improve via a strategy that combines evidence and advocacy to stimulate accountability. The present paper explains the methods used to collect baseline monitoring data using two tools developed to inform program design in six focus countries. The first tool is designed to understand the extent to which decision-makers have access to the data they need, when they need it, and in meaningful formats, and then to use the data to prioritize, plan, and allocate resources. The second tool seeks the views of people working in the area of maternal and newborn health (MNH) about political will, including: quality of care, the political and financial priority accorded to MNH, and the extent to which MNH decision-makers are accountable to service users. Findings indicate significant potential to improve access to and use of data for decision-making, particularly at subnational levels. Respondents across all six program countries reported lack of access by ordinary citizens to information on the health and MNH budget, and data on MNH outcomes. In all six countries there was a perceived inequity in the distribution of resources and a perception that politicians do not fully understand the priorities of their constituents