Improving Quality of Maternal Health Services in Small Private Facilities through Social Franchising in Rural and Peri-Urban Uganda

Session: What is the Local Private Health Sector and Can it Offer Quality Maternal Health Care?

Presenter: Mariam Luyiga, PACE/PSI

Background: In Uganda, the private sector plays a critical role in the delivery of health services. However, the private sector remains unregulated, leading to variability in quality of care. In 2008, PACE established the ProFam social franchise of private clinics to increase access to high-quality family planning. In 2013, with support from Merck Sharpe and Dohme, PACE integrated maternal health services into the franchise network to explore whether franchised private providers could successfully expand access to high quality maternal care, requiring a revamp of ProFam’s quality assurance system.

Methodology: ProFam’s quality assurance system is based on Population Services International’s global standards for family planning: technical competence, client safety, informed choice, privacy and confidentiality, and continuity of care.  With integration of labor and delivery care, the standards were revised, adapting Jhpiego’s SBM-R approach to develop a robust, integrated QA/QI system addressing challenges unique to maternal health in small facilities. For example, direct observation was not possible so we integrated use of drills, case studies, demonstrations and other indirect methods, requiring triangulation of data. Given the complexity, we shifted from a focus on qualitative to quantitative data establishing minimum scoring thresholds.

Results: Quality standards have been successfully adopted among small facilities with often one provider and low birth volumes. For example, partograph use increased by 27% in the first six months of mentoring. The QA/QI system also makes it possible to assess provider skills in management of labor complications, a rare occurrence in low volume facilities, using drills and simulations.  The new integrated system has been successfully used to develop a quality improvement work plan for each facility.

Conclusion: A robust, integrated QA/QI system can ensure low volume private providers deliver sustainable quality care. High quality care, without direct observation, can be assured through use of simulations, models, and drills.