1. Quality of Maternal & Newborn (MNH)
Services
An online learning resource for policy and practice
June 2015

2. Introducing the Learning Resource
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3. What is on offer?
A online learning resource on Maternal and Newborn Health (MNH)
that provides a framework for exploring the following questions:
 What can we tell about the global situation of MNH?
 What does ‘quality’ mean in the context of MNH?
 What does ‘quality improvement’ mean and which strategies are
available to achieve it?
 What approaches, indicators and data sources can we use to capture
and measure quality in MNH in LMICs?
It also provides links to an array of in-depth articles, materials and data
www.heart-resources.org 3
Note - this resource is:
a) Not a formal course experience,
b) Not a comprehensive analysis of the issues,
c) Not primarily about clinical interaction

4. Why focus on Quality of Services?
The rationale for looking at Quality of Services:
 Maximising the health gains associated with increased access to
services
 A focus on equitable, quality services may well make the difference to
accelerate efforts to reduce maternal and newborn deaths and ill health.
 ‘Services’ not ‘care’ most appropriately captures the dimensions of
greatest relevance to the cadre.
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5. Background to development
The purpose / process of the resource:
 Technical content originally defined by IMMPACT (University of
Aberdeen) and augmented by SueNewportConsulting.com.
 Response to stated need for a resource that pulls together the key
thinking, concepts and frameworks underpinning quality improvement
with technical resources and strategies.
 Intended to allow individuals to gain what they need: whether a refresh
of knowledge or opportunity to drill down into an issue.
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6. What’s inside the Learning Resource
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7. Brief overview
Four main sections of technical content, each with a different purpose:
 A: Global situation - trends, patterns, relationships, causes, impact of
different data sources
 B: Fundamentals of quality - definitions, concepts and dimensions for
consideration
 C: Quality improvement strategies - reviews approaches,
information, evidence and case studies
 D: Measuring quality and quality improvement - sources of data,
tools, complexities or measuring, capturing evidence
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8. Section A - the global situation
Get the data you need relevant to wherever you work:
 Interactive maps for maternal, newborn & adolescent reproductive health
 Links to pre-configured DHS Statcompiler maps for key countries
 Graphs charting major global and regional trends for key indicators
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9. Section A - the global situation
A comparison of estimates of maternal mortality in Nepal:
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Data Source: the Institute for Health Metrics and Evaluation (IHME)
and the Maternal Mortality Estimation Inter-agency Group (MMEIG)

10. Section B - the fundamentals
Have the models and concepts at
your finger tips:
 Explaining the key dimensions
 Distinguishing between quality
of care and of services
 Understanding the importance of
quality along the continuum of care
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11. Section B - Quality models
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The Systems Model, from Donabedian 1980

12. Section B – Quality models
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The continuum of care: the dimension of place

13. Section C – Quality improvement
strategies
Draw on a framework for considering strategies for Quality
Improvements (QI):
 Examples outlined of professional, financial, organisational and
regulatory strategies
 Reflections on the effectiveness of different QI approaches
 Exploration of safety and acceptability, as well as effectiveness
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14. Section C – Quality improvement
strategies
Professional: maternal audits, reviews, surveillance and response
 How effective have audits been?
 Challenges and benefits of audit in low and middle income settings
 What is MDSR?
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15. Section C - Quality improvement
strategies:
Other Financial Strategies:
 Where is the evidence in support of financial incentives?
 What learning is emerging from the removal of user fees?
 Where is the debate happening about the impact of performance based
financing on quality?
Other Regulatory Strategies:
 Soft and hard regulations, what is working?
Some big questions:
 What are the implications on accountability with these strategies?
 How do we ensure safety and acceptability when trying to improve quality?
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16. Section D – measuring quality and quality
improvement
Know your way around a toolkit of quality indicators (below):
 A selection of key data sources used for capturing MNH quality
 Approaches for capturing process and structural dimensions of quality
 Norms, standards and tools for use in performance management,
including EmONC (below)
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17. Guide to the Learning Resource
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18. What’s inside the box?
The resource is comprised of
 An ‘Inform’ section, containing four main sections of content
 Over 30 named sub-sections to dip into on-demand
 Technical glossary and reference guides for further reading
 An ‘Engage’ section, documenting key aspects of Engagement events
 A ‘QI in Action’ section, compiling our email updates on niche issues
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19. How to access it?
A publicly available resource…
 No log-in required
 On-screen tool for feedback
 Contact us if you need help: info@heart-resources.org
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20. How to use it?
A dip-in and dip-out experience
 Navigation elements to help you drill-down
 Interactive ‘reflections’ to prompt your thinking
 ‘Mark as read’ button to flag pages covered
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21. Engagement activities - 2015
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22. Seminar events
Summer / Autumn 2015 series of ‘Engagement’ seminars
 Three to four events in London shared globally by video conference
 Themes were:
– Financial strategies for QI – Professor Ayesha De Costa
– WASH in the context of MNH – Professor Wendy Graham
– Auditing for QI – Professor Nynke van den Broek; Dr Charles Ameh
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23. Seminar example – Financial Strategies
 Title: ‘Demand side financing programs at scale to promote access to
emergency obstetric care: The Chiranjeevi Program in India’
 Dates: Wed 22nd July, 10-11.30 am (GMT+1)
 Location: DFID, 22 Whitehall, London
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Speaker: Ayesha De Costa, Associate Professor, Karolinska Institutet,
Stockholm
Ayesha De Costa is Associate professor and Universitets lektor at the
Karolinska Institutet. She has been principal investigator and coordinated
multi country collaborations - randomised trials and non randomised
studies in Asia and Africa.
She has active research collaborations in India, Uganda, South Africa,
Sweden, Oman, the United Kingdom, China and Finland. Her areas of
research experience are: Pragmatic randomised trials, infectious
diseases, epidemiology, maternal health, health systems.
More info at: http://ki.se/en/people/ayedec