Quality Indicator Targeted | Care Gap | Change Concept | Related Qualitative theme from focus groups | Facilities successfully implementing |
---|---|---|---|---|
QI PROJECT: IMPROVING ANTENATAL CARE SERVICES (# Facilities attempting n = 23) | ||||
 4 Antenatal care visits | Low 4 ANC visit completion because women miss 1st ANC appointment | Test women for pregnancy in all departments and transfer for ANC enrollment or same day ANC care if pregnant. | Integration of services Teamwork & Communic-ation | 7 |
Low community awareness of importance of ANC visits | Increase community awareness of ANC importance by educating women in waiting rooms of the health facility | Teamwork & Communic-ation | 2 | |
Engage health center leadership to provide ANC care and demonstrate importance of ANC to the community. | Importance of Leadership | 1 | ||
Engage community leadership to help CHWs emphasize the importance of antenatal care in monthly community meetings | Importance of Leadership | 1 | ||
Health Centers too far for women to reach | Decentralize ANC services to Health Posts on a regular basis | Â | 4 | |
No mechanism to follow up women who miss appointments | Make (a) a filing system of medical records or (b) a register modification to facilitate identification of women who miss appointments for outreach by CHWs | Teamwork & Communica-tion | 3 | |
No mechanism to remind women of up-coming appointments | Have CHWs remind women who have upcoming appointments. | Teamwork & Communica-tion | 1 | |
Women cannot attend ANC clinic on the day offered | Offer ANC care at the health center more frequently (ranges from 2 times per week to daily) and at times that coordinate with community activities (such as market day) | Â | 4 | |
Women don’t come for ANC because partner is not available. | See women for 1st ANC and send her with invitation for her partner to attend following visit | Mentorship &Training | 2 | |
QI PROJECT: IMPROVING DELIVERY CARE SERVICES (# Facilities attempting n = 17) | ||||
 Time to C-section (District Hospitals only) | Poor communication and coordination between maternity and neonatal services | Set aside a regularly scheduled time for collaboration between neonatal and maternity services | Teamwork & Communication | 2 |
 Appropriate administration of steroids & antibiotics for preterm labor management | Low case identification of women in active preterm labor | Define scope of problem at health center by comparing preterm infants recorded versus women in preterm labor identified | Data utilization | 5 |
Refresher trainings for staff on calculation of gestational age and management of PPROM in order to improve recognition of labor complications & management | Mentorship & Training | 4 | ||
Medical Staff forget that steroids and/or antibiotics may be indicated in preterm birth | Modify existing maternity registers to prompt appropriate management | Integration of services Teamwork & Communication | 2 | |
Antibiotics not given because not available | Have nurses proactively checking on supply of steroids available. | Essential equipment | 1 | |
Facility-based delivery | Women not deliver at the facility because inadequate anticipatory planning | Assist mothers with anticipatory planning of items to have prepared to bring for delivery at their 3rd ANC appointment | Teamwork & Communication | 1 |
QI PROJECT: IMPROVING POSTNATAL CARE SERVICES (# Facilities attempting n = 12) | ||||
 Checking infants for Danger Signs within 24 hours | Low maternal knowledge & nurse vigilance in checking for neonatal danger signs | Make checking for danger signs part of the maternity register and assign the filling of the register as a daily nursing responsibly to prompt staff to educate the mother and check the newborn for Danger Signs | Integration of services | 5 |
Short hospital stays (often same day discharge) preclude staff from checking danger signs | When women come to get child’s BCG vaccination makes sure they are also screened for neonatal danger signs | Integration of services | 1 |