Table 2 The eight quality domains -Composite indices and indicators
Quality domains constructed based on variables from post-partum women interview and review of their delivery charts | Quality domains constructed based on variables from health centers’ survey |
|---|---|
Effective communication: Six questions were used • Greetings at reception • Introduction by the provider • Communicated the way she understands • Provided adequate information • Provided the opportunity to ask questions • Informed consent Ten women were interviewed per health center. A health center was defined as delivering effective communication when the mean score from the 10 women is. ≥ 75% (≥ 4.5 out of 6 points) | Actionable information system: ten questions used • Clinical charts are available at all times for the routine recording of care • Standard forms and/or partograph used to monitor labour • There is a mechanism for information exchange among staff (handover meeting) • Has maternal and perinatal death reviews • Has a mechanism to implement findings of maternal and perinatal death reviews • Has HMIS /DHIS2 registers in place at all time • HMIS /DHIS2 registers are routinely administered • Has a data system for analysis and regular reporting • Management and staff meet periodically to review performance reports A health center was defined to have an actionable information system when it scored. ≥ 75% (≥ 7.5 out of 10 points) |
Emotional support: Six questions were used • Encouraged to take fluid during labour • Encouraged to mobilize during labour • Encouraged to be labour position of her choice • Allowed to have a companion of choice • Companions are oriented to their role • Offered pain relief Ten women were interviewed per health center. A health center was defined as delivering emotional support when the mean score from the 10 women is. ≥ 75% (≥ 4.5 out of 6 points) | Functional referral system: eight questions used • Has a functional ambulance for referral • Has an up-to-date list of referral facilities • Has standard referral forms • Has reliable communication for referral and consultation (mobile or landline phone) • Has a formal agreement with referral centers • Registers are available for the referral of cases • regularly track and receive feedback on cases referred • always assigns professionals to accompany cases to referral facilities A health center was defined to have a functional referral system when it scored. ≥ 75% (≥ 6 out of 8 points) |
Dignified Care: Six questions were used • Clean delivery area • Delivery area ensures privacy • Delivery care ensures s confidentiality • Women did not have verbal abuse • Women did not have physical abuse • Women were not neglected • Ten women were interviewed per health center. A health center was defined as delivering dignified care when the mean score from the 10 women is. ≥ 75% (≥ 4.5 out of 6 points) | Availability of mechanism to support and motivate staff: eight questions used • Has standard procedures for recruitment & deployment of all staff • Has plans for recruitment & deployment of staff • Has periodic appraisal of the performance of staff • Has performed staff performance appraisal in the past year • Has a list of staff on rotation /duty posted in the labour room • Has the address and telephone number of staff posted for consultation and communication • Has a formal agreement with referral centers • Most staff had training or refresher on BEMONC • Most staff have received their job description • Most staff oriented on their job description A health center was defined to have a functional mechanism to motivate and support staff when it scored. ≥ 75% (≥ 7.5 out of 10 points) |
Evidence-based routine obstetric and newborn care: was measured using 34 questions • 6 questions were used to assess essential obstetric history at admission’ • 6 questions were used to assess essential physical examination at admission • 11 questions were used to measure follow and management of labour • 6 questions on newborn care • 5 questions were used to assess the practice of basic laboratory tests during labour Ten women’s delivery charts were reviewed per health center. A health center was defined as delivering Evidence-based routine obstetric and newborn care when the mean score from the 34 women is. ≥ 75% (≥ 25.5 out of 6 points) | Availability of physical resources: 58 questions or indicators used • 14 indicators for the availability of infrastructure and facility (rooms, coach, electric, water) • 20 indicators for the availability of essential obstetric and new-born care equipment • 24 indicators for the availability of essential drugs and supplies A Health center was defined to have the physical resources to deliver obstetric and newborn care when it scored. ≥ 75% (≥ 43.5 out of 58 points) |