Research Briefing: Quality of care in Malawi’s health facilities – Evidence from Maternal Death Audits

Ensuring that quality of care is provided to pregnant women in health facilities is essential to saving the lives of mothers and their babies. Maternal Death Audits (MDAs) are a system to help improve quality of care by investigating the health, social and other factors surrounding maternal deaths and ensuring the learnings from these audits are used to prevent similar deaths in the future.In Malawi, MDAs are routinely completed by maternal death review teams in health facilities. In December 2015, the Institute for Global Health, University College London, and PACHI Malawi (Parent and Child Health Initiative) carried-out an analysis of a sample of MDAs  to see whether there was a difference in the quality of care provided to pregnant women who arrived at health facilities in a stable condition compared to those who arrived critically ill. This study was commissioned by MamaYe Malawi with the purpose of  providing health providers (decision-makers, health planners, and health workers) with key findings to inform their efforts in improving quality of care in Malawi through the use of MDAs.Key findings:

• Nearly half (44%) of MDAs analysed were for women who were stable on arrival at the health facility.  This contradicts the assumption that pregnant women die because they arrive at a health facility critically ill.
• Women who arrived in a stable condition experienced poorer quality of care compared to those who arrived critically ill:
  • Critically ill women were more than twice as likely to receive essential drugs compared to stable women
  • Nearly half of stable women received incomplete initial assessments, compared to one-third for critically ill women.
  • Stable women were more than twice as likely to receive inadequate monitoring compared to women who were critically ill.
  •  There is an attitude among health workers to prioritise critical cases in order to save lives, for example, by preserving life-saving drugs for what are perceived to be critical cases.

The study recommends the following actions:

1. Ensure essential drugs are adequately stocked, so that they are available for all women across the continuum of care regardless of the condition they arrive in at the health facility.
2. Ensure that health care workers provide quality of care to women irrespective of their condition on arrival. 

To read the research briefing for free, click here. Evidence for Action (2016). Research briefing: quality of care in Malawi’s health facilities – evidence from maternal death audits. London: Evidence for Action.