Standards for improving quality of maternal and newborn care in health facilities
Overview
Much progress has been made during the past two decades in coverage of births in health
facilities; however, reductions in maternal and neonatal mortality remain slow. With increasing
numbers of births in health facilities, attention has shifted to the quality of care, as poor quality
of care contributes to morbidity and mortality.
The period around childbirth is the most critical
for saving the maximum number of maternal and newborn lives and preventing stillbirths.
WHO sees a future in which “Every pregnant woman and newborn receives high-quality care
throughout pregnancy, childbirth and the postnatal period”. To realize this vision, WHO has
defined “quality of care” and has prepared a framework for improving the quality of care for
mothers and newborns around the time of childbirth.
The framework contains eight domains of quality of care that should be assessed, improved
and monitored within the health system. The health system provides the structure for access
to high-quality care in the two important, inter-linked dimensions of provision and experience
of care. Within this framework and in line with the Organization’s mandate, WHO will work
towards realization of its vision in six strategic areas, which will be the basis for a systematic,
evidence-based approach to providing guidance for improving the quality of maternal and
newborn care.
The six areas are: clinical guidelines, standards of care, effective interventions,
measures of quality of care, relevant research and capacity-building
Standards of care and measures of quality were prioritized because there is currently no
substantive guidance, although it is the key to ensuring the quality of care. Standards explicitly
define what is required in order to achieve high-quality care around the time of childbirth. In the
first phase, a rigorous approach was used to identify existing resources, conduct an extensive
literature search and map the standards of care of various organizations in order to define and
determine their structure. It was proposed that broad standards be set, underpinned by specific
quality statements and a number of input, output or process and outcome measures. Eight
standards were formulated, one for each of the eight domains of the quality of care framework.
To ensure that the standards are specific and focused, 2–13 quality statements were formulated
for each standard to drive measurable improvements in the quality of care around childbirth.