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A newly refurbished labour room in a rural health facility Nepal, clean, well equipped and able to provide privacy for women
A labour room in a rural Nepal teaching hospital

Examining the WHO standards for improving quality of maternal and newborn care in health facilities

In 2016, the World Health Organization (WHO) published the Standards for Improving Quality of Maternal and Newborn Care in Health Facilities and we encourage you to read the executive summary.

WHO define quality of care as:

“…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.” (Standards for Improving Quality of Maternal and Newborn Care in Health Facilities, p.14).

Standards of care and measures of quality around the time of birth were prioritised, because a document review found that was no substantive guidance available for ensuring quality of care during childbirth.

WHO envisage that the framework can be used:

  • To help prepare national standards of care
  • To help prepare measures for improving, assessing and monitoring the quality of care provided to mothers and newborns in health facilities in different countries around the world
  • As a basis for new quality improvement strategies and activities
  • To incorporate quality into existing national programs in different countries.

And that it could be used by policy-makers; program managers; health planners at any level; maternal and new-born health care professionals and professional bodies; or technical partners involved in quality of care and which advise ministries of health.

Outline of the framework

The WHO framework sets out eight domains in which good quality of care is needed. These are referred to as standards. Each standard has one or more quality statement(s), with 31 in total. These are requirements to achieve compliance with the standard. Each quality statement has a number of quality measures, being the evidence that can be used to objectively decide if the standard has been met.

Structure of standards

Image source: Fig 2 in WHO. Standards for improving quality of maternal and newborncare in health facilities. 2016. [www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en]

To objectively measure quality, WHO defines inputs (what must be in place to practically achieve the standard), outputs (measures to assess the actual care provided) and outcome (on health of women and infants). The result is more than 300 distinct measures of quality!

To conclude, the focus of these standards is on clearly setting out expectations for services around birth; determining the clinical and health system requirements for achieving those standards (inputs); and transparently measuring performance in the form of outputs and outcomes.

This means that quality becomes auditable. If external, independent auditors visited a facility to check the quality of service, they could do so by looking for the physical existence of various documents, materials such as equipment or medical supplies or data collection and analysis systems as set out in the inputs, outputs and outcomes.

We will now explore each standard in turn.

Pick one of the eight standards and review one of the quality statements and the corresponding quality measures. As you did for the previous step, consider whether these are feasible measures in your setting and what would be required to be able to measure them.

World Health Organization, 2016, Standards for improving quality of maternal and newborn care in health facilities.

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