Setting up and managing a quality improvement programme at the district level; Point-of-care quality improvement; District programme management guide

Overview

For reducing maternal, newborn and child mortality, the focus has been on reaching higher coverage with key reproductive, maternal, newborn and child health (RMNCH) interventions. It has been observed that the evidence-based interventions are often delivered with insufficient quality. Several studies over the past few years have documented poor quality of care (QoC) provided to neonates and children. Similarly, deficiencies in maternal health care, for both routine and emergency care, have also been described.

Poor quality of care is harmful for the health of an individual and leads to adverse effects on future health-seeking behaviour by communities. Low utilization of healthcare services by the population can be partially attributed to the poor quality of the services. Issues of quality of care for maternal, newborn, child and adolescent health have been deliberated in several WHO-SEARO regional meetings.

The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) and the Sustainable Development Goal (SDG) framework provide further impetus to ending preventable mortality among mothers, neonates and children. Universal health care (UHC) is a centrepiece for SDG3 wherein the quality of health care is a crucial element. Quality of care is embedded in global frameworks such as Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality (EPMM). It is, therefore, mandatory that interventions are delivered with good quality, meeting appropriate standards of care.

WHO with partners has put forth a global vision for improving quality of maternal, newborn and child health (MNCH) care that emphasizes the provision of quality of care as well as improved experience of care during pregnancy, childbirth and postnatal period. WHO has worked with partners to finalize the standards for maternal and newborn health care⁸ for good-quality and respectful care, implementation guidelines and a measurement framework. Subsequently, global standards for small and sick newborn care and paediatric care have also been published.