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Ensuring Quality in Private Maternity Care

By Dr. Naveen Rao, MSD for Mothers, Hema Divakar, FOGSI; Frank Kaharuza, AOGU; Bulbul Sood, Jhpiego India

October 13, 2016

One of the most challenging areas of maternal health is measuring, improving and assuring quality of care. Measuring the quality of maternal health care can be particularly difficult, especially surrounding labor and delivery. Maternal mortality and morbidity outcomes can be misleading indicators of quality, and data on the content of care is extremely limited. For private maternity care providers, investing in continuous quality measurement and improvement can be a real hurdle. Particularly for small, independent providers, time is money and taking on complex, continuous quality improvement processes is unrealistic. However, our experience working with private providers demonstrates that they are eager to invest in quality improvement measures.

We cannot overlook private providers in quality improvement efforts, especially given new research from the London School of Hygiene & Tropical Medicine: according to their analysis, a surprising 40 percent of women in low- and middle-income countries receive maternal health care and family planning services from private providers. Yet, most countries' national quality assurance and quality improvement plans only apply to public providers, and regulation does not effectively cover private care. If we want to achieve greater progress in ending preventable maternal and child deaths, we must develop innovative strategies to improve the quality of care a woman receives—regardless of where that care takes place.

For that reason, we created the Private Maternity Care Quality Toolkit (PMC-QT)* to help measure and improve the quality of private maternity care. With financial support from MSD for Mothers (known as Merck for Mothers in the United States and Canada), the PMC-QT was designed in consultation with dozens of stakeholders in India and Uganda, including the Federation of Obstetrics and Gynaecological Societies of India (FOGSI), the Association of Obstetricians and Gynaecologists of Uganda (AOGU), Population Services International/Program for Accessible Health Communication and Education Uganda (PSI/PACE), Hindustan Latex Family Planning Promotion Trust (HLFPPT), Pathfinder International, World Health Partners and Ministry of Health representatives from both countries. Key features include clinical standards targeting the most essential evidence-based practices, clear metrics for measurement and simple data collection tools. The practical, user-friendly toolkit incorporates lessons from three years of programming and on-the-ground input from a diverse group of stakeholders in India and Uganda. It spans the entire maternity care continuum, including antenatal, intrapartum and immediate postpartum care, and was designed to be useful for doctors at large, urban hospitals and midwives in rural villages alike.

Earlier this year, Jhpiego previewed the toolkit at the Women Deliver conference where many of the private providers in the room acknowledged the usefulness of the toolkit in addressing their specific challenges and contexts. Others expressed optimism that quality standards and tools for private providers would help counter negative stereotypes about their services and, instead, demonstrate their commitment to high quality maternity care.

In August 2016, Jhpiego hosted a webinar to introduce partners and external stakeholders to the PMC-QT and plans for implementation in India and Uganda. Attendees shared challenges they face and discussed how the toolkit could help improve their quality management processes. Jhpiego will offer additional webinars to continue sharing this resource with private providers, professional associations, accreditors, regulators and government authorities. Our hope is that the PMC-QT will contribute meaningfully to global efforts to measure and improve quality of maternal health care.

To view the PMC-QT and fact sheet, visit www.pmcqt.org.

*This program is supported by funding from MSD, through MSD for Mothers, the company's 10-year, $500 million initiative to help create a world where no woman dies giving life. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, N.J., U.S.A.

This post is part of the Maternal Task Force blog series. Read the full series here.


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Naveen Rao, MD Lead, MSD for Mothers

Dr. Rao leads MSD for Mothers, MSD's signature initiative to reduce maternal mortality around the world. In this capacity, Dr. Rao is responsible for leveraging the company's science and business expertise to accelerate progress in reaching Millennium Development Goal 5 and advancing MSD's mission to improve and save lives.