Advancing maternal and newborn health care measurement: Developing quality of care indices for postnatal and small and/or sick newborn care in low- and middle-income countries

ABSTRACT Background High-quality healthcare for pregnant women and newborns, particularly postnatal care (PNC) and small and/or sick newborn care (SSNC), is essential to reducing maternal and newborn morbidity and mortality in low- and middle-income countries (LMICs). Poor quality of care is a major contributor to preventable morbidity and mortality, emphasizing the need for improvements in health service delivery, which requires measuring and monitoring quality of care (QoC). Although indicators measuring QoC have been identified, there is a current gap in the availability of composite indicators that can summarize the complex, multidimensional nature of QoC. This study systematically developed three composite QoC indices for maternal PNC, newborn PNC, and SSNC feasible to measure using existing data in LMICs. Methods A four-step process was used to define the indices: (1) Intervention selection: Key interventions were identified by reviewing global clinical guidelines and QoC frameworks; (2) Guideline review and item identification: Discrete items recommended for delivery of each of the selected interventions were extracted from intervention-specific guidelines; (3) Data mapping: These items were mapped to health facility survey data to assess their alignment with standardized tools; and (4) Final index development: A quality readiness index (QRI) was developed for each service area based on QoC frameworks, available data, and clinical guidelines. Results The maternal PNC-QRI includes 12 interventions and contains 24 items. The newborn PNC-QRI includes 3 interventions and contains 16 items. The SSNC-QRI includes 8 interventions and contains 48 items. Data gaps for maternal PNC, newborn PNC, and SSNC led to the exclusion of some evidence-based interventions and limited item inclusion. No data on provision/experience of care were available for PNC or SSNC, thus the indices reflect only facility readiness. Conclusions The three QRIs developed provide composite measures for PNC and SSNC readiness and can be adapted at country level and operationalized using health facility assessment survey data, facilitating their use by decision-makers for planning and resource allocation. Revision of existing health facility assessments to address gaps in readiness and provision/experience of care measurement for PNC and SSNC would bolster efforts to monitor and improve QoC for mothers and newborns.