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Raven J.H.,Maternal and Newborn Health Unit | Tolhurst R.J.,International Health Group | Tang S.,International Health Group | van den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2012

Objective: to review published papers and reports examining quality of care in maternal and newborn health to identify definitions and models of quality of care. Design: literature review. Search strategy: electronic search of MEDLINE and organisational databases for literature describing definitions and models of quality used in health care and maternal and newborn health care. Relevant papers and reports were reviewed and summarised. Findings: there is no universally accepted definition of quality of care. The multi-faceted nature of quality is widely acknowledged. In the literature quality of care is described: from the perspective of health care providers, managers and patients; dimensions within the health care system; using elements such as safety, effectiveness, patient-centeredness, timeliness, equity and efficiency; and through the provision of care and experience of care. Key conclusions: the importance of ensuring good quality of care for women and newborn babies is well recognised in the literature, however, there is currently no agreed single and comprehensive definition described. Several models were identified, which can be combined to form a comprehensive framework to help define and assess quality of care or lack of quality. Approaches to quality of care that are specifically important for maternal and newborn health were identified and include a rights based approach, adopting care that is evidence-based, consideration of the mother and baby as interdependent and the fact that pregnancy is on the whole a healthy state. Implications for practice: a model of quality of maternal and newborn health care using perspectives, characteristics, dimensions of the system and elements of quality of care specific to maternal and newborn health is proposed, which can be used as a basis for developing quality improvement strategies and activities, and incorporating quality into existing programmes. © 2011 Elsevier Ltd.

Adegoke A.A.,Maternal and Newborn Health Unit | Abubakar A.,Partnership for Reviving Routine Immunization in Northern Nigeria and Northern States Maternal | Van Den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2013

Objective: to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria. Design and setting: we adapted and used the ICM global standards for Midwifery Education and Essential competencies for midwifery practice to design a framework of criteria against which we assessed curricula for pre-service training. We reviewed the pre-service curricula for Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers (JCHEW) in three states. Criteria against which the curricula were evaluated include: minimum entry requirement, the length of the programme, theory: practice ratio, curriculum model, minimum number of births conducted during training, clinical experience, competencies, maximum number of students allowable and proportion of Maternal, Newborn and Child Health components (MNCH) as part of the total curriculum. Findings: four pre-service education programmes were reviewed; the 3 year basic midwifery, 3 year basic nursing, 3 year Community Health Extension Worker (CHEW) and 2 year Junior Community Health Extension Worker (JCHEW) programme. Findings showed that, none of these four training curricula met all the standards. The basic midwifery curriculum most closely met the standards and competencies set out. The nursing curriculum showed a strong focus on foundations of nursing practice, theories of nursing, public health and maternal newborn and child health. This includes well-defined modules on family health which are undertaken from the first year to the third year of the programme. The CHEW and JCHEW curricula are currently inadequate with regard to training health-care workers to be skilled birth attendants. Key conclusions: although the midwifery curriculum most closely reflects the ICM global standards for Midwifery Education and Essential competencies for midwifery practice, a revision of the competencies and content is required especially as it relates to the first year of training. There is an urgent need to modify the JCHEW and CHEW curricula by increasing the content and clinical hands-on experience of MNCH components of the curricula. Without effecting these changes, it is doubtful that graduates of the CHEW and JCHEW programmes have the requisite competencies needed to function adequately as skilled birth attendants in Health Centres, PHCs and MCHs, without direct supervision of a midwife or medical doctor with midwifery skills. © 2012 Elsevier Ltd.

Ameh C.A.,Maternal and Newborn Health Unit | Bishop S.,North West Deanery | Kongnyuy E.,Maternal and Newborn Health Unit | Grady K.,Wythenshawe Hospital | Van Den Broek N.,Maternal and Newborn Health Unit
Maternal and Child Health Journal | Year: 2011

To assess the availability of, and challenges to the provision of emergency obstetric care in order to raise awareness and assist policy-makers and development partners in making appropriate decisions to help pregnant women in Iraq. Descriptive and exploratory study based on self-administered questionnaires, an in-depth interview and a Focus Group Discussion. The setting was 19 major hospitals in 8 out of the 18 Governorates and the participants were 31 Iraqi doctors and 1 midwife. The outcome measures were availability of emergency obstetric care (EOC) in hospitals and challenges to the provision of EOC. Only 26.3% (5/19) of hospitals had been able to provide all the 8 signal functions of comprehensive emergency obstetric care in the previous 3 months. All the 19 hospitals provided parenteral antibiotics and uterine evacuation, 94.7% (18/19) were able to provide parenteral oxytocics and perform manual removal of retained placenta, magnesium sulphate for eclampsia was available in 47.4% (9/19) of hospitals, 42.1% (8/19) provided assisted vaginal delivery, 26.5% (5/19) provided blood transfusion and 89.5% (17/19) offered Caesarean section. The identified challenges for health care providers include difficulties travelling to work due to frequent checkpoints and insecurity, high level of insecurity for patients referred or admitted to hospitals, inadequate staffing due mainly to external migration and premature deaths as a result of the war, lack of drugs, supplies and equipment (including blood for transfusion), and falling standards of training and regulation. Most women and their families do not currently have access to comprehensive emergency obstetric care. Health care providers recommend reconstruction and strengthening of all components of the Iraqi health system which may only be achieved if security returns to the country. © 2009 Springer Science+Business Media, LLC.

Raven J.,Maternal and Newborn Health Unit | Utz B.,Maternal and Newborn Health Unit | Roberts D.,Liverpool Womens Hospitals Foundation Trust | Van Den Broek N.,Maternal and Newborn Health Unit
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

A training package designed to train health care providers in the management of common obstetric and newborn complications using a competency based 'skills and drills' approach is used in Bangladesh and India as one of the interventions under the 'Making it Happen' programme. The programme was commenced in 2009 and aims to reduce maternal and newborn mortality and morbidity by improving health care providers' capacity to deliver Essential (Emergency) Obstetric and Newborn Care (EOC&NC) thus increasing the availability and quality of these services. Preliminary results indicate that the training package has improved knowledge and skills of trained health care providers and ensures more signal functions of EOC are provided. © 2011 RCOG.

Utz B.,Maternal and Newborn Health Unit | Kana T.,Maternal and Newborn Health Unit | van den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2015

Objective: the use of simulation training in obstetrics is an important strategy to improve health-care providers' competence to manage obstetric cases. As an increasing number of international programmes focus on simulation training, more information is needed about the practical aspects of planning for and organising skills laboratories. Methods: systematic review of peer reviewed literature published between January 2000 and June 2014. Thematic summary of 31 papers meeting inclusion criteria. Findings: skills laboratories need to reflect the clinical working environment and are ideally located at or near a health-care facility. A mix of low and high fidelity manikins combined with patient actors is recommended to be used with clear instructions, scenario setting and short lectures including audio-visual teaching aids. Motivated trainers are vital and a focus on 'team training' in smaller groups is beneficial. Practical information needed to set up and run a skills laboratory is provided with a proposed outline of a skills laboratory for obstetric simulation training. Conclusions and implications for practice: obstetric skills laboratories can play a substantial role in increasing competency and confidence of staff via 'skills and drills' type training. When considering setting up skills laboratories, this can be simply done using low fidelity manikins in the first instance with training facilitated by motivated trainers using realistic clinical scenarios. Overall, the review findings highlight the need for better documentation of factors that promote and/or are barriers to the effective use of skills laboratories. Synopsis: 31 papers detailing the planning and organisation of skills laboratories were reviewed in order to assess the factors necessary for their effectiveness and the vital role they play in increasing staff competencies. Setting up obstetric skills laboratories is worthwhile but requires in-depth planning. © 2014 The Authors.

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