Gaps in availability and quality of
maternal health care services constitute a major obstacle to achieving the
desired maternal health outcomes in low- and middle-income countries such as
Nigeria. Initiatives aimed at improving quality of maternal health care tend to
address quality of care issues in isolation, without considering wider
system-level issues that lead to nonexistent or impaired quality of
services. The governance of health service delivery – including health care
financing, knowledge and information, human resources and commodities and
equipment – largely determine the availability and quality of care.
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| Image: cihpng.org |
Using an adapted version of the World
Health Organization governance actions, the Partnership
for Transforming the Health System II (PATHS2) Project led by Abt
Associates and implemented between 2008 and 2015 illustrates the role of
governance in improving the quality of maternal care by increasing access to
skilled birth attendants who can provide active management of the third stage
of labor (AMSTL).
Policymaking
One of the first steps towards improving
quality of maternal health care is to define quality improvement objectives,
set standards and establish clear guidelines, treatment protocols and
indicators. Clear policy direction defines quality and sets the stage for
effective implementation of a quality improvement plan. Policy directions for
other aspects of the health system also play an important role in improving
quality of maternal health care. For instance, clear human resources for health
(HRH) policies that place a premium on improved density, equitable
distribution and performance in terms of reduced absenteeism, competence,
productivity and responsiveness are critical. The PATHS2 Project in Nigeria
supported select states to develop and implement HRH policies and strategies,
recruiting additional staff and redistributing staff where necessary. In
addition, skilled health workers were trained in the AMSTL. The availability of
skilled health workers as a result of this policy change contributed to a
greater than 60% reduction in cases of postpartum hemorrhage referred from
primary health care centers (PHCs) in these states.
Institutional capacity strengthening
As part of maternal health care quality
improvement, stakeholders should clearly articulate the roles of different
institutions and address institutional weaknesses that hinder effective design
and implementation of a quality improvement initiative. Health systems need
well-functioning institutions to enact reforms related to HRH, health financing
and commodity management that improve maternal health care quality. In Nigeria,
Kaduna State created a HRH unit within the State Ministry of Health and
introduced a Supplementary
Midwife Service Scheme to recruit, train and deploy midwives to PHCs. Due
to the increase in personnel, these PHCs experienced a subsequent surge in
facility births and delivery of other maternal health services.
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News credit: Maternal Health Task Force
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