This HEART talks video is a recording of a seminar held at DFID Whitehall on 28th October 2015 and is led by Professor van den Broek, head of the Centre for Maternal and Newborn Health (CMNH) at the Liverpool School of Tropical Medicine. She commences this presentation by stressing that the majority of the CMNH’s focus is on strengthening health care facilities within health systems and that she and Dr Charles Ameh were pleased to have the opportunity to share some ideas around improving quality of care (QoC).
The presentation focused on standards based audit as CMNH’s key methodology, the linkages with maternal death audits and also the importance of effective measurement, including the outcomes of improved quality. Dr Ameh presented a case study from Kenya which reinforced many of the key points made by Prof van den Broek.
Throughout the presentation Prof van den Broek advocated for different ways of thinking about QoC, based on the assumption that women understand what is available to them and make decisions on this basis.
Traditional approaches have focused on increasing access; however is it now time to think about what should be done at health facility level to make sure women come to the facility? There is limited research but it is clear that if the QoC is poor, women and their families are less likely to visit a facility.
Three key methodologies/tools for quality of care were highlighted: Maternal audit/review, perinatal death audits; and standards based audits. There is currently insufficient robust evidence on the effectiveness of audits.
Key learning from the case study: setting up confidential enquiry into maternal deaths in Kenya include:
- Setting up the system is a long process, the advocacy requires time.
- Surveillance systems needs a more innovative approach.
- There can be a catalytic effect.
- Essential ingredients for an effective/successful maternal death and surveillance response:
- Strong structures put in place
- National committee supported by competent and motivated assessors
- National ownership
- Political will and funding
- Ownership at level of MoH and professional associations