Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement

Abstract

As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

PIP: This article outlines the quality of care in reproductive health programs by monitoring and evaluating quality improvements. Values of medical audit, verbal autopsies, and selected process and outcome indicators pertaining to safe motherhood component of reproductive health programs are illustrated to measure various aspects of quality of care. The International Federation of Gynecology and Obstetrics (FIGO) recommends the method of maternal death audits for the purpose of teaching and improving services at all level in the maternity care pyramid. In the selection process and outcome indicators, this requires collaboration between various international agencies and universities. Each projects and programs should require appropriate indicators for monitoring and evaluation; hence, the choice will depend on program interventions. The availability of humane and functioning obstetric services, which are geographically accessible and financially affordable, encourages families to seek care. Moreover, discussions in improving quality must consider client satisfaction and provider fulfillment.