Increasing access to and continuity of pregnancy and childbirth care through a quality improvement methodology: The experience from rural Armenia

Purpose: This presentation demonstrates use of a quality improvement framework in the midst of a partnership between healthcare providers and the community, and comprehensive maternal, newborn and child health (MNCH) programming to enhance and maintain quality standards in health facilities and ensure early and continual use of MNCH services. Quality assurance teams (QATs) were set up in 24 health facilities. Information used: QATs used a quality assurance cycle that helped them adopt quarterly review of health statistics, identify performance gaps, perform root cause analysis, develop, implement and revise action plans based on gaps identified. Examples of gaps included: poor sanitary and physical conditions; overall unwelcome environment; shortage of health educational materials and inability to institutionalize Schools of Motherhood (SOM). Results: QATs resolved problems through project funds and leveraged community monetary and in-kind support for renovation of 129 rural health posts and purchase of new furniture, equipment and supplies and literature for small health libraries and operationlization of 12 SOMs, with partner participation. Interaction between client and providers greatly improved. Health statistics affected: first trimester registration for antenatal care increased from 39% to 45%, proportion of women with four antenatal care visits increased from 69% to 86%, still birth rates decreased from 1.5% to 0.3%, and births covered by active management of third stage of labor increased from 0% to 97% with a subsequent decrease in incidence of postpartum hemorrhage. Recommendations: Quality improvement processes and comprehensive programming are essential to increasing access to, creation and maintenance of quality of services.