What is Quality of Care and why is it important?
Due to focused global advocacy, many countries have made progress in increasing the proportion of pregnant women who give birth in a health facility. However, this increase in coverage often has not translated in the expected reduction of maternal and newborn mortality and stillbirths. This is due to inadequacies in the quality of care provided in health facilities.
Quality of care vital for further reductions in mortality
Health facilities often struggle to provide the rapid emergency care needed to manage maternal complications and care for small and sick newborns. Common causes include inadequate or unhygienic infrastructure; lack of competent, motivated staff; lack of availability or poor quality of medicines; poor compliance to evidence-based clinical interventions and practices; and poor documentation and use of information. Improving quality of care and patient safety are therefore critical if we want to accelerate reductions in maternal and newborn mortality.
Quality of care is also a key component of the right to health, and the route to equity and dignity for women and children. In order to achieve universal health coverage, it is essential to deliver health services that meet quality criteria.
How do we define quality of care?
On the basis of several definitions in the literature, the WHO definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.”
Safe. Delivering health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors.
Effective. Providing services based on scientific knowledge and evidence-based guidelines.
Timely. Reducing delays in providing and receiving health care.
Efficient. Delivering health care in a manner that maximizes resource use and avoids waste.
Equitable. Delivering health care that does not differ in quality according to personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status.
People-centred. Providing care that takes into account the preferences and aspirations of individual service users and the culture of their community.
Developing quality standards for maternal and newborn care
In 2016, WHO published standards for improving the quality of maternal and newborn care in health-care facilities. The standards place people at the centre of the care by improving both the provision of, and patients’ experience of, health care; they are a critical part of strengthening health systems.
Competent and motivated health-care professionals
Quality provision of care for pregnant women and newborns in health-care facilities requires competent and motivated health-care professionals and the availability of essential physical resources, such as clean water, essential medicines, equipment and supplies. In addition, evidence-based practices for routine and emergency care require functional referral systems between levels of care, as well as information systems that enable review and audit to take place.
Experience of quality care requires effective communication—a woman (or her family if required) should feel that she understands what is happening to her and her baby and what to expect, and know their rights. Both a woman and her baby should receive care with respect and dignity, and a woman and her family should have access to the social and emotional support of their choice.
Community engagement is also central to improving quality of care. The perspectives of women, their families and communities, on the quality of services influence their decisions to seek care. Engagement of facility service providers with the communities they serve – so that they can understand their expectations, build trust and engage them in the process of delivery – is an essential component for creating demand for and access to quality maternal and newborn services.
The quality of care for women and newborns is therefore the degree to which maternal and newborn health services (for individuals and populations) increase the likelihood of timely, appropriate care for the purpose of achieving desired outcomes that are both consistent with current professional knowledge and take into account the preferences and aspirations of individual women and their families. This definition takes into consideration the characteristics of quality of care and two important components of care: the quality of the provision of care and the quality of care as experienced by women, newborns and their families.