Chart Audits as a Quality Improvement Strategy to Map Gaps and to Improve MCHN Outcomes in Four Districts in South Africa

Presenter: Rorisang Lesenyeho, PATH

Background: Maternal (132.9/100 000) and neonatal (14/1000) mortality rates remain high in South Africa. To lower these levels, health facilities need accurate and meaningful data to identify gaps that need urgent attention. PATH’s Window of Opportunity project, operates in four South African districts and seeks to improve the quality and range of clinical and community-based services addressing the health and development needs of mothers and children 0-2 years. Clinical chart audits is a strategy used by the project to review and interpret data, identify service quality gaps and developing action plans to improve facility performance and quality of health services.

Methodology: Project mentors conduct chart audits in 210 project supported facilities in the four districts. The audits assess the complete spectrum of maternal health and infant wellbeing service reporting and provision. Quarterly mentors sample and review 5 patient records within each service area from 10-20 health facilities per district, determine implementation gaps and create action plans to address the gaps.  Initially, chart audits were paper-based but have since advanced to an electronic tool.

Results: Chart audits have been conducted at 114 health facilities and quality improvement plans developed from these. Gaps and concerns identified during the audits included poor recording, inappropriateness/lack of patient referrals, unsuitability of treatments, and poor patient management.  Paper-based audits require the mentor to calculate and analyse results at a later stage, the electronic tool generates analyses immediately. Facility staff have also started conducting these audits independently.

Conclusion: The project’s conduct of chart audits has facilitated the measurement and analysis of the quality of essential clinical services. Results from this analysis, identify significant implementation gaps and thus form the foundation on which meaningful quality improvement plans are developed.  The improvement in the quality and range of MCHN services provided yields better health outcomes for those concerned.