Standards for improving quality of maternal and newborn care in health facilities
The Sustainable Development Goals have set ambitious health-related targets for mothers, newborns, children under the umbrella of Universal Health Coverage by 2030. Addressing quality of care will be fundamental in reducing maternal and newborn mortality and achieving the health-related SDG targets. For mothers and newborns, the period around childbirth is the most critical for saving the maximum number of lives and preventing stillbirths. In this context, WHO has elaborated a global vision where 'every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the postnatal period' under the umbrella of Universal Health Coverage and quality.' This vision is in alignment with two complementary global action agendas conceptualised by WHO and partners, namely Strategies toward Ending Preventable Maternal Mortality (EPMM)' and the 'Every Newborn Action Plan (ENAP)'.
To realize this vision, a "framework" for improving the quality of care for mothers and newborns around the time of childbirth encompassing both the provision and experience of care has been developed. The framework contains eight domains of quality of care that should be assessed, improved and monitored within the context of the health system building blocks. Within this framework and in line with the Organization's mandate, six strategic areas have been identified as a basis for a systematic, evidence-based approach to providing guidance for improving the quality of maternal and newborn care. These are clinical guidelines, standards of care, effective interventions, quality measures, and the relevant research and capability building.
This publication of the Framework, standards of care and quality measures is the first in a series of normative guidance documents that will be developed to support maternal, newborn and child quality of care improvement. The development of standards of care and measures of quality were prioritized because of lack of substantive WHO guidance in this area of work. Eight standards are formulated, one for each of the eight domains of the quality of care framework. These standards explicitly define what is required in order to achieve high-quality care around the time of childbirth to set a benchmark against which improvements can be measured to drive and monitor quality of care improvement. They are broad statements underpinned by more specific 2-3 quality statements except for standard 1 with 13, and each quality statement has a number of input, output or process and outcome measures.
Scope and use
The standards of care cover the routine care and management of complications occurring for women and their babies during labour, childbirth and the early postnatal period, including those of small babies during the first week of life. They define priorities for improving the quality of maternal and newborn care for use by planners, managers and health care providers to:
- prepare evidence-based national and subnational standards of care to ensure high-quality, effective maternal and neonatal health services around the time of childbirth;
- introduce the expected standards of care and delivery in order to identify the components of care that require improvement to ensure high-quality service;
- use available resources to achieve optimal health care outcomes and improve the use by and satisfaction of individuals, families and communities with maternal and neonatal health services;
- monitor service improvements, show that high-quality maternal and newborn care or services are being provided and highlight areas for improvement; and
- provide a benchmark for national health facility audits, accreditation and rewards for provider performance.
They should be adopted and streamlined within national quality of care strategies and frameworks for the delivery of maternal and newborn health services to ensure that the services provided are of high quality. Implementation will be supported by step-by-step country guidance which describes key processes and actions for building both institutional and individual capabilities to organize, prepare, implement, monitor and scale up quality improvement interventions to achieve optimal standards of care.