Improving the quality of intra-partum care at health facilities to achieve better maternal and newborn health outcomes in Uganda

Purpose: To address the high maternal and child mortality in Uganda, our project introduced a Quality Improvement (QI) Collaborative covering 46 health facilities in 10 districts to improve the quality of high-impact maternal and neonatal interventions. Intervention: The focus of this QI collaborative is to increase the uptake and implementation of evidence-based practices during intra-partum care, including Partograph use for monitoring labor, active management of third stage of labor (AMSTL) and provision of essential newborn care (ENC) services.

Methods: Facility QI teams were trained to analyze gaps in maternal and child health service delivery. Quality indicators were introduced to monitor performance and local solutions were developed to address gaps in service delivery. Successful changes were shared through peer learning sessions enabling facility teams to share lessons and adopt best local practices for scale-up in the health system. Results: There was increased implementation of evidence-based standards for maternal and newborn care during the intra-partum period. Partograph use increased from 9.9% to 78.5%, normal deliveries in which AMSTL was properly applied increased from 30.2% to 93.2%, and newborns who received the ENC package increased from 2% to 80%. Effective changes introduced at facilities to improve performance included on-the-job trainings, sensitization of staff to address poor attitudes in partograph use, modifying maternity registers to capture information on AMSTL, and a checklist to remind providers to offer ENC services to every newborn.

Conclusion: Supporting facilities to routinely introduce simple but effective changes can improve uptake of best practices in maternal and newborn care.