Service delivery with quality
Overview
Re-visioning maternal and perinatal health care services
Globally, an estimated 810 women died each day due to complications of pregnancy and childbirth with the majority of deaths in low- and middle-income countries in 2017. Between 2000 and 2017, the average annual rate of reduction in global maternal mortality was 2.9%, which is far short of what is needed to achieve the global Sustainable Development Goals (SDG) targets. The SDGs prioritize maternal mortality reduction, with a global average maternal mortality target of less than 70 per 100,000 live births and a supplementary national target that no country should have an MMR greater than 140 per 100,000 live births by 2030. For every woman who dies of pregnancy-related causes, many more will suffer from morbidity, disabilities and long-term ill-health. Given the current pace of progress, it is estimated that we will fall short of the SDG target by more than one million lives as well as a burden on maternal health and well-being.
WHO, in collaboration with UNICEF and UNFPA, is undertaking a maternal and perinatal health scoping review to:
- Identify best practices on how to provide evidence-based integrated people-centered maternal and perinatal care and services
- Provide guidance and recommendations on models/networks of care for optimizing maternal and perinatal outcomes across countries at different stages of the obstetric transition
These recommendations will be incorporated into the Ending Preventable Maternal Mortality Results Framework, as well as provide the basis for recommendations on maternal and perinatal health for the WHO/UNICEF revisioning of child/adolescent health well-being framework. The scoping review includes a landscaping review of networks of care for maternal and perinatal health and case studies in six countries including Cambodia, Democratic Republic of the Congo, Georgia, Guatemala, Pakistan and Sierra Leone.
Optimizing service delivery with quality - networks of care
WHO, in collaboration with UNICEF and UNFPA, are undertaking a landscaping review on networks of care for maternal and perinatal health. A network of care is defined as a collection of public and/or private health facilities and health workers deliberately interconnected to promote multi-disciplinary teamwork and collaborative learning to provide comprehensive, equitable, respectful, person-centred care from home/community to primary and tertiary levels. A functional network of care builds on the existing health system and referral systems and promotes collaborative and coordinated continuity of quality and respectful care to optimize linkages for efficient and resilient health systems.
There is a growing body of evidence that functional networks of care can strengthen relational linkages between frontline and higher-level health facilities and can improve maternal and newborn outcomes especially in low- and middle-income settings. The landscaping review includes a systematic review of the literature, a synthesis of illustrative examples from countries, and table top exercises to assess feasibility of implementing a network of care at the district level in several countries. The results will support the Maternal Health Unit in optimizing existing health systems to improve maternal and newborn outcomes.
Quality of Care
Quality of care is critical to the achievement of the Sustainable Development Goals (SDGs) and to achieving the Global Strategy for Women’s, Children’s and Adolescents’ Health (WHA69.2). However, improvements in the coverage of lifesaving interventions for maternal health have not consistently translated into reductions in mortality from preventable conditions. WHO has elaborated a global vision in which “every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the postnatal period” under the umbrella of universal health coverage.The Maternal Health Unit supports this vision, as well as the WHO Quality of Care Framework which includes equally important elements of provision of quality care and ensuring a positive experience of care. This includes engagement of stakeholders and community members and engaging with the private sector.
Relevant publications
Standards for quality of care
Quality of Care Network report
Community engagement
Stakeholder and community engagement is key to achieving person-centred health care. It promotes collaboration and gives service users and community members an opportunity to actively participate in care they receive. Stakeholder and community engagement has been identified as an integral component of improving quality of care and quality improvement (QI) initiatives. Stakeholder and community engagement has been used to positively influence designing and planning, implementation and delivery, monitoring and accountability of interventions, and building and strengthening relationships between providers and clients.
The Quality of Care Network has included stakeholder and community engagement within its implementation guidance as a core system required to support QI implementation.
To support Network countries in developing strategies and plans to integrate stakeholder and community engagement within their quality improvement initiatives, the World health Organization and UNICEF have recently published two products:
- A module to guide policy makers and programme implementers working in Quality Improvement in Maternal, Newborn and Child Health to support making comprehensive and meaningful stakeholder and community engagement an integral part of quality improvement initiatives
- A mapping of 70 tools to further support implementation of stakeholder and community engagement across the seven steps of the Quality of Care Network’s Implementation Framework.
Private sector engagement
The Maternal Health Unit is supporting mechanisms for engaging the private sector in delivering maternal and newborn health services with quality, in collaboration with the Quality of Care Network. The exploratory project documents the lessons learned from private sector delivery of quality maternal and newborn health services and identifies mechanisms and opportunities for collaboration between the public and private sectors.
The private sector plays a key role in delivering maternal and newborn health services. One in five births in low- and middle-income countries occurred with care delivered by the private sector. In most member countries of the Quality of Care Network, private health sector is one of the fastest growing segments of the healthcare system, and private providers (i.e. non-government providers for profit individuals, facilities and businesses) are an important source of health care. Whilst the private sector’s role is expanding in many countries, the quality of services varies. Little is known about how to sustain and ensure that the private sector delivers quality care in low- and middle-income countries, and what the public sector needs to do to facilitate this process. There is a need to understand what can be done to create, nurture and encourage a vibrant private sector that is fully engaged in improving and sustaining quality of care for women and newborns. Through an effective collaboration with the private sector, we have the potential for reaching more women and newborns with quality health services in accordance with their needs.
Based on findings from this project, we propose models for effective engagement of the private sector in collaborating with national governments, delivering quality maternal and newborn health services, and demonstrating accountability for quality of care for maternal and newborn health. Other countries can draw upon these models when planning and implementing their national quality of care plans and processes.
Related links
The WHO Health Systems Governance and Financing Department works to strengthen the stewardship capacity of governments to manage mixed health systems (systems made up of public and private providers). To do this, the Department helps countries to establish public policy about the means and strategies of engaging, managing, and regulating the private sector in health care service delivery. The objective of this work is to support country efforts to increase equitable access to health services, improve quality, address the risk of financial hardship, and improve accountability.
Related links:
Re-visioning maternal and perinatal health care services
Globally, an estimated 810 women died each day due to complications of pregnancy and childbirth with the majority of deaths in low- and middle-income countries in 2017. Between 2000 and 2017, the average annual rate of reduction in global maternal mortality was 2.9%, which is far short of what is needed to achieve the global Sustainable Development Goals (SDG) targets. The SDGs prioritize maternal mortality reduction, with a global average maternal mortality target of less than 70 per 100,000 live births and a supplementary national target that no country should have an MMR greater than 140 per 100,000 live births by 2030. For every woman who dies of pregnancy-related causes, many more will suffer from morbidity, disabilities and long-term ill-health. Given the current pace of progress, it is estimated that we will fall short of the SDG target by more than one million lives as well as a burden on maternal health and well-being.
WHO, in collaboration with UNICEF and UNFPA, is undertaking a maternal and perinatal health scoping review to:
- Identify best practices on how to provide evidence-based integrated people-centered maternal and perinatal care and services
- Provide guidance and recommendations on models/networks of care for optimizing maternal and perinatal outcomes across countries at different stages of the obstetric transition
These recommendations will be incorporated into the Ending Preventable Maternal Mortality Results Framework, as well as provide the basis for recommendations on maternal and perinatal health for the WHO/UNICEF revisioning of child/adolescent health well-being framework. The scoping review includes a landscaping review of networks of care for maternal and perinatal health and case studies in six countries including Cambodia, Democratic Republic of the Congo, Georgia, Guatemala, Pakistan and Sierra Leone.
Optimizing service delivery with quality - networks of care
WHO, in collaboration with UNICEF and UNFPA, are undertaking a landscaping review on networks of care for maternal and perinatal health. A network of care is defined as a collection of public and/or private health facilities and health workers deliberately interconnected to promote multi-disciplinary teamwork and collaborative learning to provide comprehensive, equitable, respectful, person-centred care from home/community to primary and tertiary levels. A functional network of care builds on the existing health system and referral systems and promotes collaborative and coordinated continuity of quality and respectful care to optimize linkages for efficient and resilient health systems.
There is a growing body of evidence that functional networks of care can strengthen relational linkages between frontline and higher-level health facilities and can improve maternal and newborn outcomes especially in low- and middle-income settings. The landscaping review includes a systematic review of the literature, a synthesis of illustrative examples from countries, and table top exercises to assess feasibility of implementing a network of care at the district level in several countries. The results will support the Maternal Health Unit in optimizing existing health systems to improve maternal and newborn outcomes.
