Launch of Network for Improving Quality of Care for Maternal, Newborn and Child Health
14-16 FEBRUARY 2017 | LILONGWE, MALAWI
Quality of care: Driving change through country leadership
24 MAY 2017 | GENEVA, SWITZERLAND
Ministers and senior policymakers from Malawi, Ethiopia and Bangladesh met on the side of the World Health Assembly in Geneva on 24 May with partners from civil society, multilateral agencies and health professional agencies to share progress in increasing quality, equity and dignity (QED) towards improved maternal, newborn and child health. The discussion, supported by Every Woman Every Child and organized by WHO, UNICEF, UNFPA and PMNCH, followed the highly successful February 2017 launch of the Network for Improving Quality of Care, held in Lilongwe, Malawi. The Network aims to reduce maternal and newborn mortality in health facilities over five years and to halve intra-partum stillbirths, starting initially with nine participating countries. The countries are Malawi, Ethiopia, Bangladesh, Ghana, Cote d’Ivoire, Nigeria, Tanzania, Uganda and India.
At the Geneva event, moderated by the WHO’s Anthony Costello, Director of Maternal, Newborn, Child and Adolescent Health, country speakers from the Quality of Care network focused on the role of leadership in delivering results through fit-for-purpose structures, tools and community-based processes. “In Malawi, we have created a directorate within the Ministry of Health focused on quality. We rely on community-level health advisory committees to report on quality of care issues to the Ministry,” explained Minister of Health Peter Kumpalume. “We have also domesticated global tools and standards to measure progress in our country. In Malawi, we are trying to create a learning environment.”
In Ethiopia, improving quality of care includes professional mentorship, with hospitals undertaking coaching of other hospitals on quality improvements – an effective system now cascading down to the health centre level. “We have learned that leadership actually matters,” said Dr Ephrem Tekle Lemango, Director, Maternal and Child Health Directorate, Federal Ministry of Health. “We are manifesting this by making sure that quality and equity become part of our agenda at all levels – through our national structures, regional steering committees and at community level. In everything we do, data is critical. If you want to improve quality, you need data at community level to guide policy change.”
A key question raised during the discussion is how to better supporting communities to demand quality of care, as well as supporting front-line health workers to deliver that care. “Can we simplify the concept of quality so that it is understood clearly by all?” asked Dr Ephrem. ‘It need not be overly technical in how we approach it.” Minister Kumpalume agreed: “The most annoying thing to a person is when they go to a facility and they don’t get what they came for. We need to sensitise people to demand quality. That is the game-changer.”
Adopting a health systems approach to quality improvements was also seen as vital, including investment in health workers and their needs. “Quality of care standards will only become a reality if midwives can wash their hands, when we have roads and electricity,” said Dr Stefan Peterson, chief of health of UNICEF. Professor Address Malata, a leading champion for midwifery in Malawi and globally through the International Confederation of Midwives (ICM), expanded on this theme: “At the heart of Quality, Equity and Dignity are midwives. Governments must invest in midwifery and encourage the use of ICM standards. You cannot have quality of care without midwives.” Dignified care for labouring women is critical, said Tariah Adams of the White Ribbon Alliance Nigeria, which campaigns for improved quality.
Yet financing health workforce and health system improvements to achieve universal health coverage is not only a question of more money for health, but better use of money. “If you think quality of care is expensive, then try poor quality of care,” said Helga Fogstad, Executive Director of the Partnership for Maternal, Newborn & Child Health (PMNCH). Ms Fogstad noted that PMNCH is leading a multistakeholder effort to improve quality, equity and dignity through joint advocacy among its 800+ members, supporting Every Woman Every Child (EWEC) and its new High Level Steering Group of champions, co-chaired by UN Secretary General Antonio Guterres, Chilean president Michelle Bachelet, and Ethiopian Prime Minister Hailemariam Desalegn. QED is one of six key focus areas promoted by EWEC champions in support of the Global Strategy for Women’s, Children’s and Adolescents’ Health and the 2030 Sustainable Development Goals (SDGs). The other five areas are adolescents’ health; sexual and reproductive health and rights (SRHR); early childhood education (ECD); women’s, girls and community empowerment; and improved health in humanitarian and fragile settings.
Other EWEC partners, including the Global Financing Facility (GFF), shared the concern about financing for results. Mariam Claeson, GFF Director said: “If you look at the first 16 countries participating in the GFF, it is clear that quality of care is at the centre. We won’t achieve the SDGs if we don’t focus on quality. .. What we need is effective demand for quality of care, and to ensure financing for scale and sustainability.”
The event closed with a personal testimonial from Dr Maria Luisa Tejada de Rivero Sawers, a Swiss obstetrician-gynaecologist who shared her experience of stillbirth while living in Mexico. Health systems, she said, must be better equipped to support parents who experience loss. The issue of stillbirths must be brought out of the shadows to receive greater attention and investment, with far stronger national monitoring processes to enable better counting and global policy attention. Dr de Rivero Sawers’s call was echoed by Anneka Knutsson of UNFPA, who provided closing remarks at the event. “We have heard many key words this evening, including leadership, demand, data, and the need for domesticated standards of care.” People are at the centre of health systems, and their experience of care matters.