Quality of care for maternal and newborn health services in sub-Saharan Africa: Results of a multi-country observational facility survey

Background: Meeting millennium development goals 4 and 5 will require not only increased coverage of maternal and newborn health (MNH) services in developing countries but improvement of their quality. Observational studies give the most accurate assessment of the quality of clinical practices.

Methods: The Maternal and Child Health Integrated Program (MCHIP) conducted cross-sectional national facility surveys in five countries -- Kenya, Ethiopia, Madagascar, Rwanda, Tanzania -- using mobile phones to measure the quality of antenatal and delivery care. Data collection included: structured clinical observations (over 4000 antenatal consultations and births); audit of facility infrastructure supplies and equipment; health provider interviews/knowledge tests (over 900); key informant interviews; and record review.

Results: Provision of active management of third stage of labor ranged from 10-60% of births observed. Oxytocin was available in 80% of facilities on average (range 65-87%). Although blood pressure was measured in 81-98% of ANC consultations and 71-85% of labor ward admissions observed, history taking and counseling for pre-eclampsia danger signs were performed for only 30-47% and 8-49% of clients, respectively. Essential newborn care was provided for 17-46% of newborns. Use of mobile phones for data collection, wireless data transmission, automated data analysis, and web-based presentation of data expedited study completion.

Implications: Findings from the study are available to Ministries of Health in the survey countries to inform MNH program planning and policy formulation. MCHIP is advocating for quality of care improvements based on study recommendations. Use of mobile technology can help make observational studies practical on a large scale.