Online Program

A community quality improvement approach to facilitate more respectful care for pregnant women and increase health worker-assisted deliveries in rural Ethiopia

Tuesday, November 5, 2013

Jen Capell, DrPH, MSc, MPH, International Health, JSI, Boston, MA
Tewabech Gebre Kirstos, MPH, BSc, JSI/L10K Project, Addis Ababa, Ethiopia
Background: Women have the right to respect and equity at all times, including when receiving health services. In recent years “respectful care” has emerged as an important driver of maternal and newborn health (MNH), and is beginning to be recognized as a core component of comprehensive quality care. Funded by the Bill and Melinda Gates Foundation, JSI Research & Training Institute, Inc. (JSI) is using a participatory community quality improvement (PCQI) approach to improve access to and quality of MNH care in rural Ethiopia. Through PCQI, community members and health workers (health extension workers, or HEWs) hold meetings to discuss quality-related issues, and together identify and implement solutions. Methods: Mixed methods were used to examine the effect of PCQI on health services access, quality, and utilization. The study included in-depth interviews with community members and HEWs in PCQI-supported communities, as well as analysis of health facility service utilization statistics for key MNH indicators including antenatal and postnatal care visits, and HEW-assisted deliveries. Results: PCQI was reported to have facilitated better relationships between HEWs and community members and more respectful care of women during antenatal care, labor and delivery, and postnatal care. In addition, the number of deliveries with a HEW (rather than with no medical assistance) increased from 1.8 to 2.5 monthly deliveries per health post (p=.048) in the 12 months after the initiation of PCQI. Conclusion: By engaging both community members and health workers in quality discussions and solutions, quality and utilization of key MNH services can be increased.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Describe at least three benefits of meaningfully engaging community members in health care quality improvement approaches. Compare the focus of health care quality improvement from a traditional, medical perspective versus a community perspective.

Keyword(s): Quality Improvement, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the research on the as part of my doctoral dissertation. Through my doctoral work (course work and thesis), as well as my five years' experience working as a monitoring and evaluation advisor at JSI, I am very familiar with quality improvement approaches and techniques, both from an implementation and a research perspective.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
JSI Global health Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.