Researchers partnered with IPA Kenya, Jacaranda Health and Kenya Medical Research Institute to assess whether quality improvement interventions could improve person-centered maternity care (PCMC) experiences for women delivering in public health facilities. While the quality improvement interventions had not led to improvements in delivery problems, quality of care, and overall satisfaction with care, PCMC, clinic quality, and women’s utilization of these clinics decreased. 

Negative experiences in medical facilities can deter women from accessing delivery, family planning, and post-abortion care services and adhering to recommended treatment. The World Health Organization prioritizes person-centered maternity care (PCMC) as an important component of quality of care.¹ Jacaranda Health—a Kenyan non-profit organization that aims to improve quality of care in health facilities—and Kenya Medical Research Institute (KEMRI) developed quality improvement (QI) interventions consisting of three cycles, each involving the implementation of QI initiatives over a three-month period. The QI interventions were developed for each health facility by a multidisciplinary team comprising health facility staff members and external QI experts to improve common healthcare challenges.

Researchers partnered with Jacaranda Health, KEMRI and IPA Kenya to assess whether the QI interventions improved PCMC experiences for women delivering in public health facilities in Nairobi and Kiambu Counties. To do so, they conducted a survey with 677 women aged 15–49 who had delivered in the last seven days. The QI interventions were implemented in three public health facilities, and three other facilities served as the comparison group. Researchers measured the implementation of PCMC on a 100-point scale that covered topics related to "Dignity and Respect," "Communication and autonomy," and "Supportive Care". The project also assessed the indirect impact of the intervention on clinical quality, provider visits, overall quality rating and satisfaction, experiences of delivery problems, and plans to use a family planning method. 

The QI interventions had not led to improvements in delivery problems, quality of care, and overall satisfaction with care. On average, the interventions decreased clinics’ PCMC scores by 5.3 points, and clinical quality decreased by 1.8 points in health facilities where these interventions were implemented, relative to the comparison group. Women in QI facilities were 73 percent less likely to frequently visit these health facilities and 55 percent less likely to use family planning after giving birth. One of the reasons the program was not effective may have been a lack of staff and supplies, which led to staff prioritizing other aspects of care over improving PCMC. Two national strikes by doctors and nurses during the intervention may have compounded the limited adherence to the intervention.

Sources

¹  Tunçalp Ö, W Were, C MacLennan, et al. “Quality of care for pregnant women and newborns—the WHO vision”. BJOG Int J Obstet Gynaecol, 2015.

Implementing Partners

Funding Partners