Standards for improving quality of maternal and newborn care in health facilities

IntroductionOver the past two decades, the numbers of births in health facilities have improved substantially leading to an increase in skilled birth attendance. With this increase in coverage has come a rise in preventable maternal and neonatal mortality and morbidity in health facilities.Maximising coverage alone is not enough to reduce mortality and morbidity. Attention must also be given to the quality of maternal and newborn care. Increased coverage should, therefore, be complemented by improved quality of care across the continuum (WHO 2016 cited by Campbell et al. 2006; Global Health Group 2014).This report aligns with World Health Organization’s vision to ensure “every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the immediate postnatal period” (p.5).Definition and framework of quality of careQuality of care is defined by the extent of maternal and newborn health services set to improve desired health outcomes by applying current professional expertise and meeting the expectations of individuals and their families.The quality of care framework has eight domains within the health system that focus on facility care but also consider community engagement as an important aspect to ensuring improvements of quality of care. Improvements are expected in two central, inter-linked areas: provision and experience of care.WHO (2016: 16)Six strategic areas of work are intended to guide improvements in the quality of care using evidence. These include “clinical guidelines, standards of care, effective interventions, measures of quality of care, relevant research and capacity-building” (p.1).  Standards of care and quality measures were prioritised as there is limited guidance for these two key areas.Standards of careA “standard” is defined by the WHO as a description of the expected provision to attain high-quality care around childbirth. The standard of care comprises two principal components: the quality statement and the quality measure. The quality statement sets out the requirements to adhere to each standard while the quality measure assesses whether the requirements have been fulfilled using evidence.  Three types of quality measures are included: input (what must be available to reach the desired provision of care), output (to assess if the desired process of care was provided as hoped) and the outcome (how the provision and experience of care affects health and people-oriented outcomes).Eight standards for each of the domains of the quality of care framework  were developed to prioritise areas of quality improvement:

1. “Evidence-based practices for routine care and management of complications;
2. Actionable information systems;
3. Functioning referral systems;
4. Effective communication;
5. Respect and preservation of dignity;
6. Emotional support;
7. Competent, motivated personnel; and
8. Availability of essential physical resources” (p.19).

Two to thirteen quality statements supplement each standard with an overall total of 31. Quality statements are specific and focused with the aim to ensure measureable improvements in the quality of maternal and newborn care.Visit here to read the full list of standards, quality statements and quality measures.To read more about WHO's vision of the quality of care for maternal and newborn health, click here.To learn about the WHO Quality Equity Dignity initiative (QED) and the Quality of Care Network click here and here.Read about global efforts to end preventable maternal and newborn mortality by visiting the EPMM and ENAP reports.World Health Organization (WHO). (2016). Standards for improving quality of maternal and newborn care in health facilities. Geneva: World Health Organization.