Step 4: Improve Quality of Care

Clinical care and treatment guidelines for prevention of PPH—along with a practical management approach for improving the performance and quality of health services—lead to meaningful, sustainable improvements in health care. Country’s key stakeholders, decision-makers and other leaders should work together to ensure responsiveness to the country’s needs and to foster the broad acceptance necessary for implementation by health care providers.

Ensure QOC tools exist and are in use: Approaches to ensure quality implementation of programs for PPH prevention and management are needed, regardless of whether the programs focus on household- or hospital-based service delivery. Programs have used various approaches, such as Standards-Based Management and Recognition (SBM-R), Client-Oriented, Provider-Efficient Services (COPE) and Improvement Collaborative to support this process. Providers at each level of the service delivery system need to have clear performance standards, as well as the support and resources to implement them. The process of promoting improved quality is equally important to facilitate and sustain change (such as described in the SBM-R process). The process will also support/strengthen supervision, infection prevention and logistics systems.

Monitor QOC across sites/facilities: When using a common set of QOC standards, it’s possible to compare quality at a single site over time or across multiple sites/facilities. This allows government, donors and stakeholders to see progress and identify areas where improvements are still needed. It also helps motivate staff and create healthy competition among facilities.

Strengthen logistics systems to plan and procure sufficient commodities to meet QOC standards: Providers need to have sufficient quantities of oxytocin and other medications and supplies for PPH prevention and treatment. As an example, too often districts only order enough oxytocin to treat hemorrhage, rather than enough to give every woman a dose during AMTSL.

Identify and address providers’ barriers to PPH prevention and management: Provider behaviors and attitudes toward PPH prevention and management need to be addressed. Job aids are practical behavior change communication tools to overcome barriers for providers.

Program Pitfalls and Lessons Learned: QOC

 Approaches to improve QOC have led to rapid increase in the use of AMTSL.

 Providers may be more motivated to offer AMTSL to all women at the time of birth if they are required to document its use in a formal hospital record.

 Availability of appropriate drugs is vital for quality care; when providers return to a facility where these drugs are not available, transfer of learning is hampered. Follow-up supervision should be in place to ensure essential resources.

 AMTSL guidelines are often only available at the BEmONC trainings. To achieve improvement in QOC, the guidelines should be widely and proactively disseminated.

 Frequent transfer of providers requires ongoing in-service training and innovative approaches to maintaining skills and knowledge among all providers at a site.