Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo. Issue 51 (30th November 2017)

• Record Type: Journal Article
• Authors: Hynes, Michelle; Meehan, Kate; Meyers, Janet; Mashukano Maneno, Leon; Hulland, Erin
• Is Part Of: Reproductive health matters. Volume 25:Issue 51(2017)
• Page Start: 140
• Page End: 150
• Publication Date: 2017-11-30
• Subjects: maternal and neonatal health care -- humanitarian conflict -- the Democratic Republic of Congo -- quality improvement -- participatory approaches -- global health security; Gynecology -- Social aspects -- Periodicals; Obstetrics -- Social aspects -- Periodicals; Women's health services -- Periodicals; Women -- Health and hygiene -- Periodicals; Human reproduction -- Social aspects -- Periodicals; Reproduction -- Periodicals; Reproductive Medicine -- Periodicals; Women's Health -- Periodicals; Women's Rights -- Periodicals; Reproduction humaine; Gynécologie; Obstétrique; Santé de la femme; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; 613.9
• DOI: 10.1080/09688080.2017.1403276
• Languages: English
• ISSNs: 0968-8080

Abstract

Abstract: Providing quality health care services in humanitarian settings is challenging due to population displacement, lack of qualified staff and supervisory oversight, and disruption of supply chains. This study explored whether a participatory quality improvement (QI) intervention could be used in a protracted conflict setting to improve facility-based maternal and newborn care. A longitudinal quasi-experimental design was used to examine delivery of maternal and newborn care components at 12 health facilities in eastern Democratic Republic of Congo. Study facilities were split into two groups, with both groups receiving an initial "standard" intervention of clinical training. The "enhanced" intervention group then applied a QI methodology, which involved QI teams in each facility, supported by coaches, testing small changes to improve care. This paper presents findings on two of the study outcomes: delivery of active management of the third stage of labour (AMTSL) and essential newborn care (ENC). We measured AMTSL and ENC through exit interviews with post-partum women and matched partographs at baseline and endline over a 9-month period. Using generalised equation estimation models, the enhanced intervention group showed a greater rate of change than the control group for AMTSL (aOR 3.47, 95% CI: 1.17–10.23) and ENC (OR: 49.62, 95% CI: 2.79–888.28), and achieved 100% ENC completion at endline. This is one of the first studies where this QI methodology has been used in a protracted conflict setting. A method where health staff take ownership of improving care is of even greater value in a humanitarian context where external resources and support are scarce.