Experience on the Development and Use of Tool for Assessing the Quality of Maternal and Newborn Health Care

and Services in Hospital and Primary Health Center in Indonesia

Dwiana Ocviyanti
*Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia *Indonesian Association of Social Obstetrician and Gynecologist
dwianaocviyanti@hotmail.com

Background
The decrease of maternal and neonatal mortality has been slow in Indonesia despite increasing access to institutional births, suggesting deficiencies in the quality of care. MoH of Indonesia working together with Indonesian Association of Social Obstetrics and Gynecology (HOGSI) and Faculty of Public Health University of Indonesia (PPK-UI) carried out a systematic assessment of the quality of maternal and newborn health care and services in hospital and primary health center by developing a tool suitable to identify priority issues and promote action.

Developing the Tool

A standard-based tool, covering 2 main areas case management support facilities Using scoring system range as A, B and C A - meet the criteria B - doesnt meet the criteria C - not found /done at all For B and C : the designated score should be completed by giving explanation on it

Area of assessment
The Quality of: antenatal care normal labor delivery newborn care, postpartum care, infection prevention monitoring and follow-up management of obstetrics complications the supporting facilities for maternal health care

References

Main references:
WHO Making Pregnancy Safer: Assessment tool for the quality of hospital care for mothers and newborn babies (Eurotools 2009) PONED & PONEK evaluation forms (2008)

Supporting references:
WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines books (2003 2006) MoH guidelines of ANC (2010) Williams Obstetrics and Gynecology (2010) Other guidelines developed by MoH and medical school

Tabel 2. Instrumen pengumpulan data Metode FASILITAS

43 instrument
Pasien K1 Sarana -

Wawancara Rumah sakit

Puskesmas Klinik Bidan Observasi/ Rekam medis Rumah sakit

Puskesmas

Petugas Kesehatan K2,K3,K4, OK1, OK2, OK3, OK4, OK5, OK6, OK7, OK8, OK9, OK10 K2,K3, OK1, OK2, OK3, OK4 K2, K3, OK1, OK2, OK3, OK4 OK1, OK2, OK3, OK4, OK5, OK6, OK7, OK8, OK9, OK10 POK1, POK2, POK3, POK4 POK1, POK2, POK3, POK4

K1 K1 OK1, OK2, OK3, OK4, OK5, OK6, OK7, OK8, OK9, OK10 POK1, POK2, POK3, POK4 POK1, POK2, POK3, POK4 OS1, OS2, OS3, OS4, OS5, OS6, OS7 OS1, OS2, OS4, OS5, OS6, OS7 OS1, OS2, OS4, OS5, OS6, OS7
7

Klinik Bidan

Consideration in selecting the indicators to be assessed

Primarily based on references Using minimum existing standards that are expected to give optimum outcome If minimum existing standards are perceived to be insufficient, guidelines based on higher standards are used as recommendations of practice Discussion with experts Indicators should produce data that are important in developing:

maternal and neonatal care and services Improvement and future interventions by the MoH ( the way forwards)

Progress of development
Begins in October 2010 Weekly/biweekly meetings (core team) Monthly/bimonthly meetings (core team,with WHO, UNFPA, MoH, PPK-UI) Meetings with reviewers (expert from professional organization and center of education)

January 2011 November 2011

Online correspondence and feedbacks from all the reviewers 1st field test at RS Budi Kemuliaan to test the tool Jul 2011 Finalisation Jan 2012

Experience in using the tool

20 hospitals, 40 government primary health centers and 40 midwifes private clinics at 10 provinces in Indonesia

Random sampling method. Sources of information

visit to services, medical records, observation of cases, interviews with staffs and mothers.

The Assessor

Multidisciplinary team (one team for each province). Each team consist of:
1 OBGYN specialist, 2 GPs 2 midwives 1 health staff from Ministry of Health 1 health consultant from international donor agency. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions

The Assessment
Training for the assessors Feb 2012 2nd field test (4 district hospital and Primary Health Center in Bogor) Feb 2012 (all member of the team practise to use the tool in real situation at the hospital and puskesmas) Assessment in 10 provinces Feb to Mar 2012

Kualitas asuhan antenatal

ASUHAN ANTENATAL Petugas melakukan: RS * Puskesmas*

Melengkapi riwayat medis

Melengkapi pemeriksaan fisik umum dan obstetri Konseling dan edukasi Pemeriksaan penunjang rutin Pemeriksaan penunjang bila ada indikasi Memberikan suplemen dan imunisasi

33,86% 50,00%

48,52% 59,38%

24,17% 39,38% 49,00%

45,00% 19,69% 52,50%

62,50%
57,50%

73,13%
72,50%

Rujukan

Kamar Bersalin
Kebersihan dan Pencegahan Infeksi
KEBERSIHAN Tersedia dan sesuai dengan standar Tidak tersedia atau tidak sesuai standar KETERSEDIAAN TEMPAT SAMPAH Tersedia dan sesuai dengan standar Tidak tersedia atau tidak sesuai standar
KETERSEDIAAN FASILITAS CUCI TANGAN Tersedia dan sesuai dengan standar Tidak tersedia atau tidak sesuai standar KETERSEDIAAN TEMPAT TIDUR OBSTETRI/BERSALIN Tersedia dan sesuai dengan standar Tidak tersedia atau tidak sesuai standar RS (n=20) 11 (55%) 9 (45%) Puskesmas (n=40) 23 (58%) 17 (42%)

2 (10%)
18 (90%)
RS (n=20) 5 (25%) 15 (75%)

3 (7%)
37 (93%)
PKM (n=40) 5 (12%) 35 (88%)

5 (25%) 15 (75%)

12 (30%) 28 (70%)

Problems
During tools development: Deciding which indicators to be investigated Defining the standards of care because the available guidelines are not yet established nationally During assessment: Varied perception among the assessors towards the score

Conclusion
A tool has been developed and could be used for assessing the quality of maternal and newborn health care. This tool had already been used and the result seemed suitable to be use as a baseline data to improve the quality of maternal and newborn health care and services in hospital and primary health center in Indonesia

*email adress: dwianaocviyanti@hotmail.com