Table 10 Service Delivery for perinatal care: Domains and indicators

Packages of Care

Implementation of the following packages of care:

1. Basic Antenatal Care

 2. Basic intrapartum care

 3. Comprehensive Emergency Obstetric Care

 4. Initiative for Newborn Care

 5. Postnatal care

 6. Kangaroo Mother Care

Referral System

1. Use of Situation Background Assessment Recommendation (SBAR) in referring patients

 2. Effective communication between labour ward and referring clinic or CHC at both management and health care professional level

 3. Effective communication between district hospital labour ward and regional hospital labour and neonate wards at both management and health care professional level

 4. Providing feedback on patient progress to referring clinic or CHC

 5. Receiving feedback on patient progress from regional hospital labour and neonate wards

Continuity of care

1. Handover between shifts consistently done per patient

 2. Standardized handover between EMRS (obstetric ambulance) and labour ward

 3. Standardized handover between EMRS (obstetric ambulance) and neonatal ward

Clinical guidelines

1. Accessibility of clinical guidelines for intrapartum care

 2. Accessibility of clinical guidelines for neonatal care

 3. Display of guidelines for emergency intrapartum care

 4. Display of guidelines for emergency neonatal care

 5. Adherence to intrapartum and neonatal care clinical guidelines

Responsiveness to patient needs

1. Cleanliness of maternity and neonate wards

 2. Cleanliness of medical equipment for perinatal care

 3. Patient satisfaction with regards to care received from health care professionals

Outreach Program

1. Obstetrician from regional hospital visit labour ward monthly to provide outreach services (i.e. auditing of quality of care, auditing of files, on-site training, ward rounds, emergency drills, etc.)

 2. Pediatrician from regional hospital visit labour ward monthly to provide outreach services (i.e. auditing of quality of care, auditing of files, on-site training, ward rounds, emergency drills, clinical care, etc.)

 3. Members of District Clinical Specialist Team (DCST) team visit labour

 4. ward at least once a month to provide outreach services (i.e. auditing of quality of care, auditing of files, on-site training, ward rounds, emergency drills, clinical care, etc.)

 5. Telephonic clinical support from specialist in regional hospitals

Perinatal Audit Process

1. Preparatory meeting for perinatal mortality and morbidity review meeting occur monthly

 2. Perinatal review meetings occur monthly

 3. Perinatal review meetings result in clear action plans

 4. Action plans are followed up in the subsequent meetings

 5. Impact of decisions taken are evaluated and discussed in perinatal review meetings

 6. The following stakeholders attend perinatal review meetings

 a. Hospital manager

 b. Medical OR Clinical Manager

 c. Nursing manager

 d. Assistant nursing manager (responsible for maternity and paediatric units)

 e. Labour ward operational manager

 f. Primary Health Care (PHC) Manager based in district hospital

 g. CHC or Clinic operational managers

 h. Doctors working in labour unit

 i. Advanced midwives

 j. Midwives

 k. Community care givers (CCG) facilitator

Audits

1. Health care professionals and operational manager audit adherence to guidelines for intrapartum and neonate care

 2. Perinatal mortality and morbidity are audited by health care professionals and operational managers in hospital together with DCSTs at least four times a year

Staff attitude

1. Health care professionals treat patients with respect

 2. Health care professionals having respect towards their fellow colleagues irrespective of professional rank or discipline