Everyone should be able to access good quality healthcare in a way and place that is right for them. Yet in many countries across the developing world, health services simply do not meet the needs of their populations. Every day, 800 women die from preventable causes related to pregnancy and childbirth. Two million seven hundred thousand babies die every year during the first month of life. If we are to increase maternal and neonatal survival, we urgently need to improve the quality of service delivery for mothers and their babies.
We promote quality of care across seven areas:
- Strengthening human resources so that health workers are proficient, regulated, respectful and motivated, and deliver services using recommended standards and guidelines
- Improving infrastructure in line with basic quality of care requirements
- Ensuring that equipment and medicines are properly stored, maintained and used by trained and skilled staff
- Improving clinical practice to ensure that care is provided in line with internationally recognised guidelines and within the context of national policies
- Establishing institutional structures which promote gender equality and social inclusion at all levels of the health system to encourage respect and equity for all service users
- Strengthening continuity of care by building networks of care and integration from the community up and the secondary/tertiary facility down
- Developing rapid tools to provide actionable data that can inform the design of strategies to scale up services and build on what works.
Strategic partnerships and collaboration are essential in order to scale up quality improvements, ensure continuity and add value to existing efforts. The technical assistance we provide has contributed to measurable improvements in health outcomes:
- In Tanzania, our work in Mara Region through the Evidence for Action (E4A) programme has promoted the careful use of evidence to build political will for change, inform priorities and ensure that plans are made real. As a result, more women are giving birth in health centres and accessing postnatal care. There has also been a substantial decline in the number of women dying from complications related to pregnancy and childbirth in health facilities.
- In Nigeria, our work in the DFID-funded Partnerships for Transforming Health Systems programme focuses on increasing governance within the health sector to deliver accessible, accountable and equitable services. Since 2008, our support has established nearly 700 functional Facility or Ward Health Committees across Kaduna, Kano, Jigawa, Enugu and Lagos States. Involving citizens in their local health facility in this way has led to significant improvements in the quality of services.
- In Sierra Leone, we use scorecards to help improve Emergency Obstetric and Newborn Care (EmONC). Facility Improvement Team (FIT) scorecards show gaps in EmONC readiness in an actionable traffic light format, based on the results of government FIT assessments. The scorecards also inform community members of the minimum standards that facilities should meet. As a result, citizens are empowered with the evidence they need to hold decision-makers to account.
We are at the forefront of designing tools and innovations to support improvements in quality of service delivery. The low-cost Quality of Institutional Care (QuIC) tool developed by our experts enables service providers to make rapid assessments of their performance and service quality and then make quick decisions on how to improve services. We also package and use evidence to prompt improvements in quality of care and increase pressure for change.
In Nigeria 90% of Facility Health Committees supported by our programme made direct contributions to improving services
In Mara Region in Tanzania, the regional strategy has led to upgrading 11 centres Emergency Obstetric Care Centre and deployment of 183 new health staff
Sarah Barnett, PhDSarah Barnett has over 17 years’ experience in national and international public health, focusing on monitoring and evaluation within reproductive and maternal health, including assessments of quality of care. She has extensive experience in Nepal, India, Bangladesh, Tanzania, Kenya and Cambodia. Sarah has designed and implemented interventions to reduce maternal and neonatal mortality and large-scale prospective surveillance systems to monitor maternal and neonatal care-seeking behaviour, home care practices and mortality.
Nicole Sijenyi FultonNicole has 15 years’ experience in the health sector, as a nurse in Canada, and as a programme and organisational leader in several sub-Saharan African countries. She is a public health specialist with experience in sexual and reproductive health (SRH), HIV/AIDS, maternal and newborn health and refugee health. Nicole is the Team Leader for the DFID-funded Maternal and Newborn Improvement (MANI) project in Kenya. Prior to joining Options, she was the Country Representative for mothers2mothers (m2m) Kenya, leading the organisation’s growth strategy and the successful national adoption and scale up of the Mentor Mother model.
Dr Kwalombota KwalombotaDr Kwalombota Kwalombota is a trained clinical professional with over ten years’ experience in health systems strengthening, comprehensive emergency and obstetric care, reproductive health and family planning. He is experienced in providing technical advice for maternal and child health and public-private partnerships in health. Kwalombota has worked for international NGOs, private sector consultancies, universities, and the Zambian Ministry of Health, where he established the only district paediatric antiretroviral treatment and care programme. He has worked in Ethiopia, Malawi, Nigeria, Sierra Leone, South Sudan and Uganda.
Rachel CullenRachel Cullen is a population and health specialist with 20 years’ experience providing monitoring, evaluation and research support to international and UK health sector organisations. She has skills in methodological design, data collection and analysis for the evaluation of studies ranging from small-scale pilots to large district-wide quantitative and qualitative surveys. She combines technical monitoring and evaluation skills with practical experience as a UK NHS commissioner, performance manager and trustee of health services and applies her understanding of the challenges in health service delivery in the UK to promoting improved quality of care in Africa and Asia.
Dr Maureen Dar IangDr Maureen Dar Iang has over 20 years experience in the planning and delivery of maternal and newborn, reproductive and child health programmes. She has played a key role in strengthening district health systems in Nepal, building capacity of service providers, and supporting national policy discussions on safe motherhood and family planning. She is coordinating our support to recovery of essential health care services in earthquake affected districts.