Assessment of Quality of Reproductive, Maternal, Newborn, Child, and Adolescent Health Care in Uganda and Kenya
The USAID Office of Health Systems (OHS) and USAID Office of HIV/AIDS (OHA) in Washington tasked the Applying Science to Strengthen and Improve Systems Project (ASSIST) team to develop a survey toolkit for assessing the quality of integrated Reproductive, Maternal, Newborn, Child, Adolescent Health (RMNC+A) including HIV services for pregnant women, exposed infants, sick children, and adolescents and to test the tools in 2-3 priority Preventing Child and Maternal Death (PCMD) and PEPFAR countries, as existing facility-based tools did not provide the information necessary for this type of assessment.
In 2017-2018, the survey toolkit was developed, and the tools were tested and implemented in 10 selected facilities in Uganda and 11 facilities in Kenya. Selection criteria included: PEPFAR/USAID-supported districts or counties, suggested by USAID field team, facilities with no on-going external Quality Improvement (QI) intervention in maternal or RMNCH services; high volume and/or high maternal and <5 mortality facilities; facilities representing all levels of the health service delivery system that provide RMNC+A and HIV services within each selected district and are connected with referral linkages; and facilities where a similar assessment had not been recently performed. Data for this study were collected May 2017-February 2018. The majority (80%) of sample facilities in Uganda were Health Center level (38% Level 3 and 62% Level 4) while the majority in Kenya were Hospital level (73%).
Uganda and Kenya have adopted World Health Organization (WHO) recommendations for RMNC+A services to varying degrees, with the degree to which adopted recommendations have been implemented unclear. The aim of this study was to describe the quality of RMNC+A health services and to gather evidence of the extent to which evidence-based (EB) interventions are being implemented. Services of focus were antenatal care (ANC), delivery and newborn care, outpatient care of the sick child and young infant, adolescent health services, and patient-centered care. The content of the childbirth section of the assessment and supporting systems for quality improvement are largely based on the WHO Quality of Care Standards for Maternal and Newborn Care.
Additionally, Uganda and Kenya are identified as two of three countries in the world with the largest HIV epidemics. Both have adopted the main WHO recommended policies for integrated HIV services and for services for Prevention of Mother to Child Transmission (PMTCT). This report shares finds of the assessment of quality of reproductive, maternal, newborn, child and adolescent health care in Uganda and Kenya.