Sexual and reproductive health

The WHO near-miss approach

Effective interventions to reduce mortality and morbidity in maternal and newborn health already exist. Information about quality and performance of care and the use of critical interventions are useful for shaping improvements in health care and strengthening the contribution of health systems towards Millennium Development Goals 4 and 5.

Near-miss concept

Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications. This similarity led to the development of the near-miss concept in maternal health. Exploring the similarities, the differences and the relationship between women who died and those who survived life-threatening conditions provide a more complete assessment of quality in maternal health care.

The near-miss concept and the criterion-based clinical audit have been proposed as useful approaches for obtaining useful information on maternal and newborn health care. Based on that, WHO is conducting a large multicountry study with the main objectives of determining the prevalence of maternal near-miss cases in health facilities, evaluating the quality of care using the maternal near-miss concept and the criterion-based clinical audit, and developing the near-miss concept in neonatal health. A total of 370 health facilities from 29 countries is taking part in this study and, by the end of 2011, over 275 000 observations about mothers and babies will have been produced. The findings of this study and other projects using similar approaches will enable a comprehensive dialogue with governments, professionals and civil societies, health systems or facilities for promoting best practices, improving quality of care and achieving better health for mothers and children.

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