Introduction: Quality of care is recognized internationally as an unfinished agenda. In low and middle-income countries (LMICs), efforts towards quality improvement and comprehensive approach to childbirth have been indicated as strategies to reduce stillbirths, maternal and early neonatal deaths, and to promote gender equality and women’s empowerment. Brazil has a context of worrying perinatal health indicators and intense medicalization of birth that contrasts with very high levels of institutional births assisted by skilled professionals and free access to care, pointing to poor quality as a key issue to be addressed. In spite of this, there is scarcity of both research and programmes aimed at improving quality of care in comparison with the international scenario. Methods: A WHO standard based, participatory approach and quality improvement tool for maternal and neonatal care was used in a sample of 6 (six) maternity hospitals in the State of Pernambuco, Brazil, that were responsible for 29.128 live births in 2014. The main objective was to assess the quality of care and to define a Plan of Action for improvements together with health professionals. The tool was translated into Portuguese and a national team of assessors was trained. Monitoring visits were also performed after the initial assessment visit, to strengthen the Plan of Action implementation at facility level. After one year, all maternity hospitals were reassessed and the observed improvements were compared with the Plan of Action developed a year before. The factors that positively or negatively influenced changes were also analyzed. Results: All maternity hospitals presented a variety of quality gaps. Teaching/tertiary care hospitals and secondary care hospitals were equally affected. Gaps in case management were predominant but infrastructure and staffing issues were also common. Monitoring visits were useful to increase awareness regarding quality gaps and commitment to change. Health professionals and managers received very well the participatory approach of the quality improvement process. After one year, some improvements were observed in all maternity hospitals, mainly in case management and respectful care. Besides the quality cycle, other factors influencing change were financial crisis, staff and manager’s motivation, leadership strategies and quality research project and monitoring. The total cost of the intervention was 8.305,62 US dollars per each maternity hospital. Conclusions: Our systematic standard-based and participatory approach produced some significant results in a relatively short time at a relatively low cost, as previously shown in other health systems settings. It should be considered, preferably linked to certification/accreditation processes and performance-based mechanisms, for use at large scale in Brazil and other LMICs.

Quality of Maternal and Neonatal Health Care: Assessment and Improvement in Six Maternity Hospitals in Pernambuco, Brazil / PESSA VALENTE, Emanuelle. - (2017 Mar 27).

Quality of Maternal and Neonatal Health Care: Assessment and Improvement in Six Maternity Hospitals in Pernambuco, Brazil

PESSA VALENTE, EMANUELLE
2017-03-27

Abstract

Introduction: Quality of care is recognized internationally as an unfinished agenda. In low and middle-income countries (LMICs), efforts towards quality improvement and comprehensive approach to childbirth have been indicated as strategies to reduce stillbirths, maternal and early neonatal deaths, and to promote gender equality and women’s empowerment. Brazil has a context of worrying perinatal health indicators and intense medicalization of birth that contrasts with very high levels of institutional births assisted by skilled professionals and free access to care, pointing to poor quality as a key issue to be addressed. In spite of this, there is scarcity of both research and programmes aimed at improving quality of care in comparison with the international scenario. Methods: A WHO standard based, participatory approach and quality improvement tool for maternal and neonatal care was used in a sample of 6 (six) maternity hospitals in the State of Pernambuco, Brazil, that were responsible for 29.128 live births in 2014. The main objective was to assess the quality of care and to define a Plan of Action for improvements together with health professionals. The tool was translated into Portuguese and a national team of assessors was trained. Monitoring visits were also performed after the initial assessment visit, to strengthen the Plan of Action implementation at facility level. After one year, all maternity hospitals were reassessed and the observed improvements were compared with the Plan of Action developed a year before. The factors that positively or negatively influenced changes were also analyzed. Results: All maternity hospitals presented a variety of quality gaps. Teaching/tertiary care hospitals and secondary care hospitals were equally affected. Gaps in case management were predominant but infrastructure and staffing issues were also common. Monitoring visits were useful to increase awareness regarding quality gaps and commitment to change. Health professionals and managers received very well the participatory approach of the quality improvement process. After one year, some improvements were observed in all maternity hospitals, mainly in case management and respectful care. Besides the quality cycle, other factors influencing change were financial crisis, staff and manager’s motivation, leadership strategies and quality research project and monitoring. The total cost of the intervention was 8.305,62 US dollars per each maternity hospital. Conclusions: Our systematic standard-based and participatory approach produced some significant results in a relatively short time at a relatively low cost, as previously shown in other health systems settings. It should be considered, preferably linked to certification/accreditation processes and performance-based mechanisms, for use at large scale in Brazil and other LMICs.
27-mar-2017
TAMBURLINI, GIORGIO
29
2015/2016
Settore MED/38 - Pediatria Generale e Specialistica
Università degli Studi di Trieste
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2908122
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