Research Article: Bridging the quality chasm in maternal, newborn, and child healthcare in low- and middle-income countries

Date Published: December 12, 2017

Publisher: Public Library of Science

Author(s): Lars Åke Persson

Abstract: In a Perspective, Lars Åke Persson discusses the need to focus on quality of care to improve maternal, newborn, and child healthcare.

Partial Text: WHO describes quality of care, as “the extent to which healthcare services provided to individuals and patient populations improved desired outcomes. In order to achieve this, healthcare must be safe, effective, timely, efficient, equitable, and people-centred” [9]. Three decades ago Avedis Donabedian developed a conceptual framework in which quality of care was classified under 3 categories: structure (material and human resources and organizational structure), process (giving and receiving care), and outcome (effects on health status) [10].

The framework suggested by WHO for improving the quality of care for mothers and newborns includes 8 components aligned to the health-system building blocks that should be assessed, improved, and monitored [9]. So far the existing tools and information systems are not adequate for measuring quality of care [12]. Measures do not reflect the process of care, and the experiences of patients are rarely represented. In a recent analysis of 68 quality checklists from a wide range of low- and middle-income countries, the indicators mainly focused on facility infrastructure and availability of resources [13]. In a metareview of almost 100 systematic reviews of interventions to improve the quality of care, the facilitators and barriers identified were in the domains of information, patient-population engagement, leadership, regulations and standards, organizational capacity, models of care, communication, and satisfaction [14]. There are few tools available to measure these facilitators and barriers; the Context Assessment for Community Health (COACH) tool is one of very few questionnaire instruments that has been developed and validated in low- and middle-income countries and includes context indicators in similar domains as the metareview [15].



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