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What is on offer?
A online learning resource on Maternal and Newborn Health (MNH)
that provides a framework for exploring the following questions:
What can we tell about the global situation of MNH?
What does ‘quality’ mean in the context of MNH?
What does ‘quality improvement’ mean and which strategies are
available to achieve it?
What approaches, indicators and data sources can we use to capture
and measure quality in MNH in LMICs?
It also provides links to an array of in-depth articles, materials and data
Note - this resource is:
a) Not a formal course experience,
b) Not a comprehensive analysis of the issues,
c) Not primarily about clinical interaction
Why focus on Quality of Services?
The rationale for looking at Quality of Services:
Maximising the health gains associated with increased access to
A focus on equitable, quality services may well make the difference to
accelerate efforts to reduce maternal and newborn deaths and ill health.
‘Services’ not ‘care’ most appropriately captures the dimensions of
greatest relevance to the cadre.
Background to development
The purpose / process of the resource:
Technical content originally defined by IMMPACT (University of
Aberdeen) and augmented by SueNewportConsulting.com.
Response to stated need for a resource that pulls together the key
thinking, concepts and frameworks underpinning quality improvement
with technical resources and strategies.
Intended to allow individuals to gain what they need: whether a refresh
of knowledge or opportunity to drill down into an issue.
Four main sections of technical content, each with a different purpose:
A: Global situation - trends, patterns, relationships, causes, impact of
different data sources
B: Fundamentals of quality - definitions, concepts and dimensions for
C: Quality improvement strategies - reviews approaches,
information, evidence and case studies
D: Measuring quality and quality improvement - sources of data,
tools, complexities or measuring, capturing evidence
Section A - the global situation
Get the data you need relevant to wherever you work:
Interactive maps for maternal, newborn & adolescent reproductive health
Links to pre-configured DHS Statcompiler maps for key countries
Graphs charting major global and regional trends for key indicators
Section A - the global situation
A comparison of estimates of maternal mortality in Nepal:
Data Source: the Institute for Health Metrics and Evaluation (IHME)
and the Maternal Mortality Estimation Inter-agency Group (MMEIG)
Section B - the fundamentals
Have the models and concepts at
your finger tips:
Explaining the key dimensions
Distinguishing between quality
of care and of services
Understanding the importance of
quality along the continuum of care
Section B - Quality models
The Systems Model, from Donabedian 1980
Section B – Quality models
The continuum of care: the dimension of place
Section C – Quality improvement
Draw on a framework for considering strategies for Quality
Examples outlined of professional, financial, organisational and
Reflections on the effectiveness of different QI approaches
Exploration of safety and acceptability, as well as effectiveness
Section C – Quality improvement
Professional: maternal audits, reviews, surveillance and response
How effective have audits been?
Challenges and benefits of audit in low and middle income settings
What is MDSR?
Section C - Quality improvement
Other Financial Strategies:
Where is the evidence in support of financial incentives?
What learning is emerging from the removal of user fees?
Where is the debate happening about the impact of performance based
financing on quality?
Other Regulatory Strategies:
Soft and hard regulations, what is working?
Some big questions:
What are the implications on accountability with these strategies?
How do we ensure safety and acceptability when trying to improve quality?
Section D – measuring quality and quality
Know your way around a toolkit of quality indicators (below):
A selection of key data sources used for capturing MNH quality
Approaches for capturing process and structural dimensions of quality
Norms, standards and tools for use in performance management,
including EmONC (below)
What’s inside the box?
The resource is comprised of
An ‘Inform’ section, containing four main sections of content
Over 30 named sub-sections to dip into on-demand
Technical glossary and reference guides for further reading
An ‘Engage’ section, documenting key aspects of Engagement events
A ‘QI in Action’ section, compiling our email updates on niche issues
How to access it?
A publicly available resource…
No log-in required
On-screen tool for feedback
Contact us if you need help: firstname.lastname@example.org
How to use it?
A dip-in and dip-out experience
Navigation elements to help you drill-down
Interactive ‘reflections’ to prompt your thinking
‘Mark as read’ button to flag pages covered
Summer / Autumn 2015 series of ‘Engagement’ seminars
Three to four events in London shared globally by video conference
– Financial strategies for QI – Professor Ayesha De Costa
– WASH in the context of MNH – Professor Wendy Graham
– Auditing for QI – Professor Nynke van den Broek; Dr Charles Ameh
Seminar example – Financial Strategies
Title: ‘Demand side financing programs at scale to promote access to
emergency obstetric care: The Chiranjeevi Program in India’
Dates: Wed 22nd July, 10-11.30 am (GMT+1)
Location: DFID, 22 Whitehall, London
Speaker: Ayesha De Costa, Associate Professor, Karolinska Institutet,
Ayesha De Costa is Associate professor and Universitets lektor at the
Karolinska Institutet. She has been principal investigator and coordinated
multi country collaborations - randomised trials and non randomised
studies in Asia and Africa.
She has active research collaborations in India, Uganda, South Africa,
Sweden, Oman, the United Kingdom, China and Finland. Her areas of
research experience are: Pragmatic randomised trials, infectious
diseases, epidemiology, maternal health, health systems.
More info at: http://ki.se/en/people/ayedec
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