title: Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.
abstract: The Standards Based Management and Recognition (SBM-R©) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services.
  
  
  
  A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups.
  
  
  
  There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother.
  
  
  
  The SBM-R quality improvement intervention made a significant positive impact on MNH providers' performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government's five-year (2015-2020) health sector transformation plan and health care quality strategies needed to meet the country's MNH goals.
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia. Firew.Ayalew@Jhpiego.org.
authors.forename: Firew
authors.initials: F
authors.lastname: Ayalew
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Gizachew
authors.initials: G
authors.lastname: Eyassu
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Negash
authors.initials: N
authors.lastname: Seyoum
authors.affiliation: Athena Institute, VU University, Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.affiliation: Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Bazant
authors.affiliation: Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, USA.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Alemnesh
authors.initials: A
authors.lastname: Tekleberhan
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gibson
authors.affiliation: Jhpiego Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Ephrem
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.|Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D000068097:Maternal Health / Q000592:standards*; D008427:Maternal Health Services / Q000592:standards*; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care / Q000592:standards; D011785:Quality Assurance, Health Care; D058996:Quality Improvement / Q000592:standards*
keywords: Antenatal care; Ethiopia; Labor and delivery; Maternal health; Newborn health; Postnatal care; Provider performance; Quality improvement; SBM-R