Tools for Improving Quality of Care for Mothers and Newborns: A Review and Gap Analysis of Critical Environmental Conditions

Despite the importance of these critical conditions, an estimated one in 50 health care facilities (HCFs) in low- and middle-income countries (LMICs) provide basic water, sanitation, hygiene (WASH) and waste management services. Many HCFs in LMICs lack IPC items, with an estimated 77% of facilities with disposable gloves available, 26% with guidelines for standard precautions, 44% with gowns, and 7% with eye protection for health care workers. Inadequate infrastructure, lack of environmental hygiene items, and inconsistent compliance with IPC practices contribute to health care-acquired infections (HCAIs). An estimated 16% of patients in LMICs develop one or more infections when visiting an HCF. Infections account for 22% of neonatal deaths and 11% of maternal deaths. The costs of treating HCAIs are substantial: The average cost to treat an HCAI is $25,000 in the US, $12,155 in Mexican intensive care units, and was estimated at $22,873 in one Indian hospital. The Maternal and Child Survival Program (MCSP) is a global, $560 million, 5-year cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support scale-up of high-impact health interventions among USAID's 25 maternal and child health priority countries, as well as other countries. MCSP is focused on ensuring that all women, newborns, and children most in need have equitable access to quality health care services to save lives. MCSP supports programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. To address the gaps in quality of care (QoC) and quality improvement (QI) tools for maternal and newborn health (MNH), MCSP conducted a review of 25 critical conditions for safe care, including conditions on WASH, waste management, environmental cleaning, and IPC. Each tool was scanned for the presence of these 25 conditions, and the results were tabulated to document patterns, trends, and gaps. The review found that many QoC/QI tools do not describe the critical conditions necessary to enable safe and dignified care for patients. The review also found that hand hygiene, one of the most important infection prevention measures, was only referenced in about half of the tools reviewed. The review identified 25 critical conditions for safe care, including conditions on WASH, waste management, environmental cleaning, and IPC. These conditions include water source type, water availability, distance to water source, and additional water considerations, as well as sanitation type, functional sanitation, private sanitation, and meets the needs of women. The review found that many QoC/QI tools do not cover these critical conditions, and that there is a need for consistent and comprehensive integration of these conditions within QoC/QI tools.