Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

Publish Date: June 2015
Author: Vandana Tripathi, Cynthia Stanton, Donna Strobino, Linda Bartlett
Language: English

Improving quality of care is essential to achieve the new global targets for ending preventable maternal and newborn deaths. The global community has recognized the need for better measures of the quality of maternal and newborn health services. In particular, little information is available about the content of care provided to women and newborns. Many measures focus on service availability or utilization, or on outcomes that are difficult to compare across facilities and programs. There is little information about the actual processes of care – the interventions women and newborns receive during the crucial intrapartum and immediate postpartum period. Additionally, many quality measures are based on expert opinion, but have not been validated.

In a study funded by MCHIP and published in PLOS ONE, the authors report on the development and validation of a streamlined, comprehensive index to measure the quality of facility-based labor and delivery services, including essential newborn care. This study combined expert opinion on the dimensions and indicators of quality of care with rigorous empirical evaluation of proposed indicators using data from the observation of more than 1,1000 facility deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar) through the MCHIP Quality of Care Surveys supported by USAID.

The index developed through this study performed well on validity measures, such as representing most key dimensions of care quality and discriminating between well- and poorly-performed deliveries. The index includes 20 indicators, covering all stages of labor and delivery as well as immediate postpartum care. The index also integrates indicators of maternal care with interventions for the newborn. This condensed set of indicators can be used to evaluate routine labor and delivery care more easily using the gold standard of clinical observation. The tool may improve knowledge regarding the quality of facility-based care for mothers and newborns in sub-Saharan Africa and help programs target their quality improvement efforts.

The full, open access article is available here.