Improving systems of essential obstetric care in Ecuador, Honduras, and Nicaragua: Results and challenges

The Quality Assurance Project worked with Ministries of Health in three countries to undertake a regional essential obstetric care (EOC) improvement collaborative from 2003-2005. The aims of the collaborative were to establish local EOC systems with improved compliance with standards for routine obstetrical care (prenatal and delivery) and management of obstetrical complications. The collaborative was successful in stimulating efforts at the national level to review and update standards of obstetric care and at the facility level to improve health worker competence and quality of routine obstetric care. Among other indicators tracked by the collaborative, correct use of the partograph rose from 40% to 87% of deliveries in participating facilities in Nicaragua; from 44% to 94% in Ecuador, and from 42% to 72% in Honduras. The practice of active management of the third stage of labor rose from 15% to 67% in Ecuador, from 69% to 100% in Nicaragua, and from 92% to 100% in Honduras. The original collaborative did not meet its goal of achieving significant gains in quality of care for the management of obstetric complications. A separate collaborative focused specifically on management of obstetric complications was started in Ecuador in 2006. The improvement collaborative approach is an effective strategy for achieving large-scale improvement, but a single collaborative broadly aimed can only address so many issues. To complement gains in routine basic essential obstetric care, specific improvement initiatives that focus mainly on obstetrical complications are needed to address quality of care issues that most directly affect excess maternal mortality.