Quality of Antenatal and Childbirth Care in Selected Rural Primary Health Care Facilities in Burkina Faso, Ghana and Tanzania: an Intervention Study

Session: Quality in Context: How Can Facility-Based Maternal Newborn Care Be Improved?

Presenter: Els Duysburgh, International Centre for Reproductive Health, Ghent University
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Background: The QUALMAT project aimed to improve quality of antenatal and childbirth care through addressing the ‘know-do’ gap by implementing financial and non-financial performance-based incentives to increase health workers’ motivation and a computer-assisted clinical decision support system to improve health workers’ compliance with established standards of care. This study documents changes in quality of antenatal and childbirth care between intervention and non-intervention health facilities and before and after the intervention.

Methods: An intervention study was conducted in rural primary health care facilities in Burkina Faso, Ghana and Tanzania. Per country two rural districts – one intervention and one non-intervention – were identified. In each district, six facilities were selected. WHO guidelines were used as standard for good quality. Quality assessment was conducted in each facility using: health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records and maternal and child health registers at health facilities and districts. Findings of pre- and post-intervention quality assessments were analysed and assessed for significant (p<0.05) quality of care differences.

Results: Overall, post-intervention quality scores do not differ from pre-intervention scores and scores of non-intervention facilities, except for a few variables. Post-intervention care shows similar important gaps as at baseline and non-intervention study facilities. Counselling and health education practices are poor, laboratory investigations are often not performed, examination and monitoring of mother and newborn during childbirth are inadequate, partographs are poorly used. None of the post-intervention health facilities performed assisted vaginal delivery. Management of obstetric complications was substandard.

Conclusion: Our intervention study couldn’t show an improvement in quality of care during the study period. However the use of new technology seems acceptable and feasible in rural primary health care facilities in resource-constrained settings creating the possibility to use this technology to address identified quality and knowledge gaps.