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Table 2 Summary of solution themes and proposed actions for quality care during labour and birth (part B).

From: Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

 

Essential medical list

• Include drugs and commodities needed during labour and childbirth in the national supply lists for e.g.: partograph, vacuum extractor, oxytocin.

 

Logistics management

• Strengthen logistics management systems and national capacity through use of appropriate and available communication technologies.

Essential Medical Products and Technologies

Infrastructure and equipment

• Institute centralised blood data storage and blood donation camps.

  

• Ensure essential equipment is available for BEmoC at first level facilities including vacuum extractors and forceps.

  

• Rationally expand number of caesarean section services across the country and provide caesarean section kits.

 

Increase service delivery

• Expand the number of 24/7 services, especially the availability of BEmOC and assisted vaginal delivery services.

 

Quality of Care

• Improve quality of care through improved mentorship and robust performance monitoring and supportive supervision systems for SBAs.

Health Service Delivery

 

• Improve remuneration and incentives (working hours, food provision) to improve working conditions, motivation and promote respectful care practices.

 

Strengthen referral care

• Improve referral links and transportation systems through context based planning to ensure inequities in access are minimised.

 

Strengthen and integrate health management information systems

• Strengthen vital registration systems at national and local level.

  

• Improve reporting systems and tools to ensure data quality and build national capacity for data-driven decision making (e.g. dashboard).

Health Information System

 

• Institutionalise regular spot checks to see whether indications for caesarean section were followed.

  

• Incorporate community and private facility data into national HMIS.

 

Perinatal death audits and registers

• Institutionalise maternal and perinatal death audits and quality assurance mechanisms with full audit cycle based on action and accountability.

 

Health promotion, education, community engagement

• Sensitisation and health education to improve demand for quality obstetric care, respectful care and access to skilled birth attendance and emergency obstetric care.

Community Ownership and Participation

 

• Develop innovative community partnership models and promote transparency and social accountability for obstetric services.

 

Male involvement

• Promote male involvement through use of male role models, inclusive policies and more targeted health education.

 

Improve Referral linkages

• Strengthen continuum of care from household to health facilities through functional communication, transport and referral services.

  

• Establish functional communication, transport and referral services.