Case Study: Experience Applying and Tracking a Quality Improvement Approach for Maternal and Newborn Health Services in Sub-Saharan Africa.

The Standards-Based Management and Recognition (SBM-R(®)) approach to quality improvement was applied to maternal and newborn health services in Guinea, Mozambique, Nigeria and Zimbabwe. In every country, the quality of service delivery, as measured by clinical performance standards, improved following the intervention. The performance of evidence-based service delivery practices, as measured through service statistics, also increased and institutional rates of postpartum hemorrhage and very early neonatal deaths exhibited declining trends. Findings suggest that the effects of SBM-R reach beyond service delivery processes to health outputs and outcomes and demonstrate the potential returns of investing in quality improvement approaches.

Measuring coverage in MNCH: testing the validity of women's self-report of key maternal and newborn health interventions during the peripartum period in Mozambique.

BACKGROUND: As low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum. METHODS AND FINDINGS: The study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75