Abstract
Objectives
The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level.
Methods
PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer.
Results
An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.
Significance
Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care.
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Data Availability
All data extraction forms and search strategies are available upon request.
Code Availability
Not applicable.
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Acknowledgements
We wish to thank all other data collectors including Dorsai Boresh Navard and Raquel D'Souza. There was no source of funding for this research.
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EA, SP and ARN: developed the proposal and decided on the methodology for this project. SP and EA led data collection and training of data extractors. SP, TJL, PM, RJ, WS, and EA: conducted data collection. SP, KB and EA: conducted data analysis. SP: wrote the draft of the manuscript. ARN’s previous work contributed to the draft of this manuscript. All authors reviewed and approved the manuscript.
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Appendices
Appendix 1
Included studies and data extraction
https://docs.google.com/spreadsheets/d/1hKsDMRZQBq8b9IKbjpRUWxSn3bf71uFuJZUiWg0majE/edit?usp=sharing
Appendix 2
See Table 2.
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Pavalagantharajah, S., Negrin, A.R., Bouzanis, K. et al. Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis. Matern Child Health J 27, 1742–1753 (2023). https://doi.org/10.1007/s10995-023-03702-8
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DOI: https://doi.org/10.1007/s10995-023-03702-8