Collaborative Improvement of Prenatal Care to Prevent and Control Zika in Selected Countries of Latin America and the Caribbean
During the extension period (2017-2019) of the United States Agency for International Development (USAID) Applying Science to Strengthen and Improve Systems (ASSIST) Project, as part of the USAID response to the Zika virus epidemic in Latin America and the Caribbean (LAC), the USAID ASSIST Project applied continuous quality improvement and collaborative learning methods to strengthen prenatal care, newborn care, and care and support for children affected by the Zika virus during their mother’s pregnancy.
The USAID ASSIST Project’s Zika care improvement work was implemented in two phases, beginning in 2017. In the first phase, health facilities in the Dominican Republic, El Salvador, Guatemala, Honduras, and Nicaragua participated; in the second phase, activities in the original countries expanded, and new Zika improvement programs were launched in Ecuador, Paraguay, and Peru. This report is focused on these eight Latin American countries; however, ASSIST also supported Zika care improvement activities in five countries of the English-speaking Caribbean.
The Prenatal Care (PNC) Collaborative in the context of Zika engaged 384 quality improvement teams in the same number of health facilities in the eight assisted countries in the LAC region. These teams sought to prevent and manage Zika during pregnancy through four improvement objectives: 1) increase the screening for Zika signs and symptoms in pregnant women who come to health facilities; 2) incorporate Zika prevention messages in prenatal counseling; 3) increase the distribution of condoms to pregnant women to prevent sexual transmission of Zika during pregnancy; and 4) increase the knowledge of pregnant women about sexual transmission of Zika and the use of condoms to prevent it.
To measure results and the effectiveness of improvement interventions, five indicators were tracked that were linked to these improvement objectives: 1) percentage of pregnant women who are correctly assessed for Zika signs and symptoms during prenatal care; 2) percentage of pregnant women who receive Zika counseling during PNC; 3) percentage compliance with quality counseling criteria for prenatal counseling as established in the project’s Counseling Guide; 4) percentage of pregnant women who received condoms for the prevention of sexual transmission of Zika during PNC; and 5) percentage of users of family planning (FP), PNC, and post-partum care who know about the risk of sexual transmission of Zika and the use of condoms to prevent it.
This document synthesizes the learning from improvement teams in the participating facilities in the LAC Region, highlighting the interventions that teams found to be effective in improving indicator performance. The specific objectives of this synthesis are to: a) describe the phases of the regional PNC improvement collaborative, the activities included in each phase, and the actors involved; b) present the results; c) describe the effective change ideas that QI teams implemented to improve performance; d) identify implementation challenges and successes and other lessons learned; and e) provide recommendations for future work.