title: Obstetric audit in resource-poor settings: lessons from a multi-country project auditing 'near miss' obstetrical emergencies.
abstract: This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations.
authors.affiliation: Maternal Health Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.forename: Ruairi
authors.initials: R
authors.lastname: Brugha
authors.forename: Edmund
authors.initials: E
authors.lastname: Browne
authors.forename: Valerie
authors.initials: V
authors.lastname: Gohou
authors.forename: Alberta
authors.initials: A
authors.lastname: Bacci
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
authors.forename: Amina
authors.initials: A
authors.lastname: Sahel
authors.forename: Sourou
authors.initials: S
authors.lastname: Goufodji
authors.forename: Eusebe
authors.initials: E
authors.lastname: Alihonou
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: D000349:Africa; D003906:Developing Countries; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008429:Maternal Welfare; D008485:Medical Audit; D009774:Obstetrics; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*