Identification of a Short QoC Index to Measure the Quality of Facility Routine L&D Care in Sub-Saharan Africa

Skilled birth attendance is the most commonly used measure of progress towards maternal mortality reduction, but it does not provide information about the actual quality of care provided during labor and delivery. There is an increasing recognition that quality of care must improve to achieve further reductions in maternal and newborn mortality. A short quality of care index was developed to measure the quality of facility routine labor and delivery care in Sub-Saharan Africa. The index is based on five quality dimensions prioritized by experts, including technical quality, interpersonal care quality, screening and monitoring, infection prevention/control, and avoidance of harmful/non-indicated practices. The index includes 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. The development of the quality of care index involved a global literature review, a modified Delphi process with global maternal and newborn care experts, and secondary data from the MCHIP QoC Assessments across three countries. The experts rated over 130 items used in the QoC Assessments' structured L&D observation checklist for their importance and representation of key dimensions of quality of care. Combinations of indicators rated by the experts were used to create potential indices of L&D care quality that were evaluated for their validity. The final validated facility labor and delivery quality index demonstrated excellent ability to discriminate between poorly and well-performed deliveries based on observations of care from the MCHIP QoC Assessments. The index can be used for more efficient and potentially cost-effective measurement of the quality of L&D care processes at health facilities. This study is unique in that it used data derived from actual observations of L&D care, which are relatively rare in low-resource settings. The recommended quality index for facility L&D care includes initial evaluation items such as checking the woman's HIV status, asking about headaches or blurred vision, and taking blood pressure. The index also includes items related to technical quality, interpersonal care quality, screening and monitoring, infection prevention/control, and avoidance of harmful/non-indicated practices. The index can be used to improve the quality of care provided during labor and delivery in Sub-Saharan Africa.