QUALMAT

Quality of maternal and prenatal care: bridging the know-do gap

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 Obiettivo del progetto (Objective)

'Besides a dramatic lack of financial and human resources in developing countries, health care is additionally endangered by quality deficiencies caused by low staff motivation. This lack of motivation leads to an insufficient translation of knowledge into optimal utilization of resources. The “know-do” gap represents a challenge that must be addressed to strengthen health services performance towards achieving the Millennium Development Goals (MDGs). This is in particular true for some sensitive sectors like pre-natal and maternal health care. General objective of this research is to improve maternal health through better pre-natal and maternal care services offered by better motivated health workers. A computer-assisted clinical decision support system (CDSS) will be developed, implemented and tested aiming at (I) quality improvement of maternal and newborn care and (II) assessment of provider’s performance. Based on this tool a commonly agreed incentive scheme to increase motivation will be shaped and tested in three SSA - countries, namely Burkina, Ghana, and Tanzania. The incentive scheme might contain both non-monetary and monetary incentives and will be designed according to the human resource policy in the three countries. The planned approach is an implementation study with control arms containing one hospital and 6 first line health facilities in each of the study districts and an equal number of facilities in the control arm. A set of indicators for measurement of changes in quality of delivered services will be identified in order to follow up the sustainability and effectiveness of the strategies after their implementation. The study findings will allow understanding the important factors of staff motivation and facilitate adequate management for improvement of maternal and neonatal health care. “Knowing is not enough, we must apply; Wanting to do, is not enough, we must do it ” - J.W. v. Goethe'

Introduzione (Teaser)

Poor maternal and prenatal care has long been a problem in developing countries. An EU-funded project tested interventions designed to improve the quality of care.

Descrizione progetto (Article)

The 'Quality of maternal and prenatal care: Bridging the know-do gap' (http://www.qualmat.net/ (QUALMAT)) project conducted studies of maternal and prenatal care in Burkina Faso, Ghana and Tanzania. The project aimed to understand the 'know-do gap', or the disconnect between the competence of health care workers and the quality of their care. The project also investigated whether a computer-assisted clinical decision support system (CDSS) was an effective tool in improving quality of care.

Project results showed that lack of training or knowledge were not the reasons for poor care. Rather, the format of guidelines needs to be prioritised to increase their usability. Other reasons for inadequate care include poor education and counselling, inadequate laboratory investigations, lack of monitoring during childbirth and a shortage of necessary equipment during childbirth. Addressing these issues could reduce maternal and neonatal mortality and morbidity, although counselling does not appear to be an effective way to educate this population.

The project addressed the know-do gap through a qualitative study measuring the impact of incentives on motivation. In-depth interviews revealed differences in ideas about motivation, underscoring the need to tailor incentive schemes to each country. Researchers also found that a mix of financial and non-financial incentives was acceptable to most health care workers. Furthermore, they appeared to increase motivation.

Project members distributed the final version of the CDSS to the partner countries, with the system designed to provide guidance and clinical decision support during antenatal care visits and delivery. Preliminary results showed that providers are using the CDSS, with more patients entered into the system than expected. Data from more in-depth studies about the system's impact on quality of care and motivation of health care workers are currently being collected and analysed.

Findings from the project have the potential to be applied to other developing countries. As a result, project efforts could lead to improvements in maternal health in other countries.