Effect of Participatory Community Quality Improvement on Maternal and Newborn Health Care Practices: A Quasi-Experimental Study

Session: Innovative Community-Based Approaches to Caring for Mothers and Newborns

Presenter: Wuleta Betamariam, JSI Research & Training Institute, Inc.

Background: Covering a population of about 17 million people in 115 districts, the Last Ten Kilometers Project (L10K) supports Ethiopia’s Health Extension Program (HEP) to improve reproductive, maternal, newborn and child health (RMNCH) care practices. L10K improves the skills of health extension workers to 1) support communities to ensure targeted RMNCH services to households; 2) conduct family conversations for birth preparedness; and 3) implement strategies to ensure early postnatal care. In addition, in 14 districts, PCQI is implemented to augment L10K’s primary objectives. PCQI fosters partnership between communities and service providers to create shared responsibility in the ownership of MNH services provided by the HEP aimed at improving service quality from three perspective—i.e., provider, client and community. PCQI ensures continuous quality improvement through a cyclical process that identifies barriers to quality services (from the three perspectives), develops action plan to address barriers, implements the action plan, and monitors the quality of improvement solutions. We analyze the effect of PCQI on MNH care practices.

Method: Data from cross-sectional survey of women with children 0 to 11 months conducted in December 2010 and January 2015 were used. MNH care practices associated with the most recent pregnancy and childbirth among the respondents were compared between PCQI and non-PCQI areas using multi-level random effects models that adjusted for pre-intervention differences in the respective MNH care practices, socio-economic background characteristics, and study design effect.

Results: The study indicated that the coverage of 4+ antenatal care, having neonatal tetanus protected childbirth, skilled birth attendance, and immediately initiating breastfeeding were 8, 8, 11, and 5 percentage-points higher (p<0.05) in the PCQI areas compared to the non-PCQI areas.

Conclusion: Engaging communities as part of the HEP service delivery strategy using PCQI is effective. Community participation should be considered an integral part of health systems in developing country settings.