Evaluating quality of obstetric care in low-resource settings: building on the literature to design tailor-made evaluation instruments--an illustration in Burkina Faso

Abstract

Background: There are many instruments available freely for evaluating obstetric care quality in low-resource settings. However, this profusion can be confusing; moreover, evaluation instruments need to be adapted to local issues. In this article, we present tools we developed to guide the choice of instruments and describe how we used them in Burkina Faso to facilitate the participative development of a locally adapted instrument.

Methods: Based on a literature review, we developed two tools: a conceptual framework and an analysis grid of existing evaluation instruments. Subsequently, we facilitated several sessions with evaluation stakeholders in Burkina Faso. They used the tools to develop a locally adapted evaluation instrument that was subsequently tested in six healthcare facilities.

Results: Three outputs emerged from this process:1) A comprehensive conceptual framework for the quality of obstetric care, each component of which is a potential criterion for evaluation.2) A grid analyzing 37 instruments for evaluating the quality of obstetric care in low-resource settings. We highlight their key characteristics and describe how the grid can be used to prepare a new evaluation.3) An evaluation instrument adapted to Burkina Faso. We describe the experience of the Burkinabé stakeholders in developing this instrument using the conceptual framework and the analysis grid, while taking into account local realities.

Conclusions: This experience demonstrates how drawing upon existing instruments can inspire and rationalize the process of developing a new, tailor-made instrument. Two tools that came out of this experience can be useful to other teams: a conceptual framework for the quality of obstetric care and an analysis grid of existing evaluation instruments. These provide an easily accessible synthesis of the literature and are useful in integrating it with the context-specific knowledge of local actors, resulting in evaluation instruments that have both scientific and local legitimacy.

Figure 1

Conceptual framework for the quality of obstetric care. ¹Number of human resources on staff and on duty 24 hrs/day, 7 days/week. ² Qualification is the fact, for example, of having a degree in medicine, midwifery, etc.; this is not to be confused with competence, which is expressed in the care process: qualification and competence are not automatically interrelated. ³ A person's interest in pursuing the objectives of the organization for which he or she works. ⁴ Should be available at all times, functional, and in sufficient quantity. ⁵ Including buildings and support services (sterilization, laundry, etc.). ⁶ E.g. team organization, job descriptions, regular payment of salaries, sanctions and rewards, etc. ⁷Should be in user-friendly formats and well maintained. ⁸ E.g. review of cases having negative outcomes, collecting patient's opinions on services received, etc. ⁹ Such that women are not required to pay anything before receiving obstetric services. ¹⁰ Between the caregiver and the patient. ¹¹ Characteristics of the setting within which care is provided that help put the patient at ease (for example, not only are there curtains--a material resource--in the delivery room, but the caregivers actually take care to close them to protect the women's privacy). ¹² All of the single interactions, and how they are interconnected, from the beginning to the end of the patient's treatment. This looks at how services are organized. ¹³ Within the health facility and, if the patient is referred, from one facility to another. ¹⁴ All the services required are provided. ¹⁵ Abusive fees charged by certain healthcare professionals, which are a flagrant sign of bad practices.