Towards maternal and newborn survival in the WHO South-East Asia Region. Implementation experience of the WHO SEARO model of point-of-care quality improvement (POCQI)

Overview

As per the latest UN estimates, under-five mortality in the WHO South-East Asia (SEA) Region has declined by nearly 72% and neonatal mortality by 62% between 1990 and 2018. Yet, about 1.2 million under-five children, including 0.7 million neonates, died in 2018 in the WHO SEA Region as per UN estimates released in 2019.

Between 2000 and 2017 the WHO South-East Asia Region experienced the largest decline in maternal deaths, witnessing a 57.3% reduction in mortality compared with the global level of 38%. An estimated 61 000 women died in 2015 in the Region due to pregnancy-related causes. At the same time, stillbirths remain a hidden challenge with about 0.8 million stillbirths reported annually from the SEA Region.

This progress in mortality reduction in the SEA Region can be related to an increase in the coverage of some life-saving, evidence-based interventions. For example, the proportion of institutional deliveries has increased by 78% in the Region over the past decade. However, this should have resulted in a higher reduction of maternal and newborn mortality if good quality of care (QoC) had been ensured.

For reducing maternal, newborn and child mortality during the Millennium Development Goals (MDG) phase the focus had been on reaching higher coverage with key reproductive, maternal, neonatal and child health (RMNCH) interventions. It has been observed that several evidence-based interventions are often delivered with inadequate quality. A number of studies over the past years have documented poor quality of care provided to neonates and children. Similarly, deficiencies in maternal health care, for both routine and emergency care, have also been described in such studies.

This is not only harmful for the health of the individual but may also lead to adverse impact on future health-seeking behaviours by communities. Universal coverage of healthcare services, as promoted by the World Health Organization, lays strong emphasis on good quality of care. It is, therefore, mandatory that interventions are delivered with sufficient quality, meeting appropriate standards of care.