Measuring to improve maternal and newborn care.

A health facility assessment using new signal functions to measure provision of routine and emergency maternal and newborn care


Photo: Caroline Trutmann Marconi/ Save the Children

“What gets measured gets done.” A first step towards improving the provision of care for mothers and newborns is measurement. However, measurement becomes complicated when it comes to quality, in part because quality is hard to define. What makes something good quality? The individual components, what is done with them, how it is done, or the result of what is done?  There are also different perspectives to take – and whose opinion counts? 

Signal functions are key interventions to prevent or treat major causes of morbidity and mortality, and are meant to “signal” the state of available care in facilities. A short list is chosen because they should represent the environment necessary for them to be performed. In maternal care, well-known signal functions are used to assess the level of emergency obstetric care (EmOC) in health facilities, corresponding to the major causes of maternal death. However, maternal care is not only about the mother and not only about emergencies. Because complications can happen at any time to any pregnant woman, it is important that women deliver with a skilled attendant who can recognize and treat or refer complications, for mother and newborn. This means providing routine delivery care safely to all women giving birth in facilities, and immediate postnatal care to all newborns.

Last year a set of 23 signal functions for routine and emergency maternal and newborn care was proposed in PLoS Medicine. This article is the first to utilize these new signal functions in a census of 86 health facilities in the Brong Ahafo region in Ghana. Our results show an overall low level of care with emergency neonatal care performing the worst of all four quality dimensions we evaluated. We found that the hypothesis that facilities providing high quality care for mothers also provide high quality care for newborns doesn’t hold. Only 3% of facilities performed all newborn signal functions and had the staffing necessary for comprehensive emergency neonatal care, compared to 13% providing comprehensive EmOC.

Although 68% of women in the study region delivered in a health facility in 2009, only 18% delivered in a health facility providing high quality care in all dimensions. This “quality gap” between women delivering in a facility and those delivering in a high quality facility, represents a huge missed opportunity. These women have already overcome barriers to deciding to seek care, and barriers to accessing care. We owe it to them, their babies and their families to ensure that facilities provide high quality care so their effort is worth it. 

Don’t miss Robin Nesbitt’s (et al.) new article in PLoS One on delivery care quality in Ghana: Quality along the Continuum: A Health Facility Assessment of Intrapartum and Postnatal Care in Ghana


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