Ways to improve the quality of care in health facilities
There is increasing global awareness that good quality care is key to keeping mothers and babies alive and well. Today, each year there are a significant number of deaths of women during pregnancy and childbirth, stillbirths, and so on. Better care can prevent many of these deaths. This story describes some of World Health Organisation's (WHO) recommendations on how countries can improve quality of care in their health facilities and prevent maternal and newborn deaths, based on its standards for improving quality of maternal and newborn care in health facilities.
Pregnant women should receive the right care, at the right times: A woman should see her health provider at least 8 times during her pregnancy to detect and manage potential problems. Antenatal care also offers an opportunity for health workers to provide a range of support and information to pregnant women, including on healthy lifestyles, preventing diseases, and family planning.
Newborns should receive essential care immediately after birth: Newborns should be kept in skin-to-skin contact on their mother's chest and enabled to breastfeed. They need to be kept clean and warm, and given care for their eyes and umbilical cord. Bathing should be delayed for 24 hours, vitamin K and vaccines given as per national guidelines, temperature monitored, and complications identified and managed.
Small and sick babies should be well cared for in a facility: Small babies (such as preterm or low birth weight babies) should be kept warm at all times and fed with their mothers' own breast milk. Mothers should be supported to practise kangaroo mother care as the baby's condition allows.
All women and newborns must receive care that prevents hospital-acquired infections: Hospital-acquired infections increase the risk of death and disease. Standard precautions are essential to prevent hospital-acquired infections which include washing hands with soap and water or alcohol-based hand rub before and after examining a patient, safely storing and disposing of infectious waste and sharp objects, and sterilising and disinfecting instruments in the labour and delivery room and newborn care area.
Health facilities must have an appropriate physical environment: Health facilities must have water, energy, sanitation and waste disposal facilities which are functional, reliable, and safe. The space needs to be designed and maintained to allow for privacy and facilitate the provision of quality services.
Communication with women and their families must be effective and respond to their needs: Patients should receive all information about their care and should feel involved in all decisions made regarding their treatment. Effective communication between health providers and patients can reduce unnecessary anxiety and make childbirth a positive experience for a woman, even if she experiences complications.
Women and newborns who need referrals can obtain them without delay: Health facilities should have available transport services that operate 24 hours a day, 7 days a week, to transport women and newborns as necessary. A list of known network facilities and their telephone numbers should be readily available. The referral system is also supervised and accountable, with a policy that protects women from financial barriers.
Health facilities need well-trained and motivated staff consistently available to provide care: All labour and childbirth areas of the health facility should have competent staff and skilled birth attendants present 24-hours a day. Common barriers for midwifery personnel to provide quality care include low social esteem, poor pay, long working hours, insufficient staffing, and lack of fully functioning facility environments.
Every woman and newborn should have a complete, accurate, and standardised medical record: All babies should receive a birth certificate. Details of newborns, including vaccinations, gestational age, birth weight and examination findings, should be recorded in a system that allows the linking of women and their newborns in all records.
Source: World Health Organisation