Improving Care of Mothers and Babies: A guide for improvement teams

This guide describes a simple approach through which health care providers and improvement teams can plan, test, implement, continuously assess, refine, and sustain interventions to improve care of mothers and babies. The guide can be used by a leader or facilitator to help others learn about improvement both at clinical and workshop settings.  It may also be used as a self-study manual by improvement teams.

The guide explains six steps to improve maternal and newborn care, using a running example of the story of how staff in a small facility followed these six steps to provide better care for newborns. The six steps are:

  1. Create an improvement team
  2. Decide what to improve
  3. Choose the barriers to overcome
  4. Plan and test change
  5. Determine the change resulted in improvement
  6. Make improvement the norm

For each of these six steps, the guide provides content to lead the user through learning, practice, and action: objectives, key knowledge, practice exercises, and group discussions.  There are two versions of the guide available in English- one developed for Africa and another for use in Asia; as well as a version in French and in Spanish.

Developed for Africa For use in Asia In French In Spanish

A separate file of appendices to the guide —a newborn practice exercise, a maternal practice exercise, tools for identifying barriers, and examples of process and outcome indicators—may be downloaded separately below.

Improving Care of Mothers and Babies was conceived and designed by an interdisciplinary team of clinicians, quality experts, and educators from the Survive & Thrive Global Development Alliance (S&T GDA).  The guide was edited by Carl Bose, MD, University of North Carolina at Chapel Hill, and Jorge Hermida, MD, University Research Co, LLC, Quito, Ecuador.  Dr. Hermida’s contributions to the development of the guide were made possible by the generous support of the American people through the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project.  

The guide was reviewed by experts from within the S&T GDA (USAID, ACOG, IHI, USAID ASSIST, Laerdal, Jhpiego, USAID Maternal and Child Survival Program, Save the Children), international experts and key global, regional and national stakeholders (including representatives of the Bill and Melinda Gates Foundation, WHO, UNICEF, International Confederation of Midwives, PATH, University of Utah, AIIMS, WHO SEARO, Malawi Ministry of Health, Bangladesh Pediatric Association, and UNICEF Nepal).

An early draft of this guide was introduced in a workshop in Nicaragua, and sections of subsequent drafts were introduced at a WHO SEARO Workshop. The guide was revised based on input from reviewers and these workshops.  

This guide may be freely copied and distributed for non-commercial purposes but may not be used, reproduced, distributed, displayed or exploited for any party’s commercial advantage, profit or monetary gain. The materials may be modified and adapted without permission, provided that the adaptation: 1) acknowledges the original work and its editors, 2) includes a statement that it is an adapted work and a web address to the original work, and 3) notification is given to the copyright holders (American Academy of Pediatrics and University Research Co., LLC) regarding the adaptation.

The American Academy of Pediatrics has made links to additional resources that may be helpful to users of Improving Care of Mothers and Babies, including a number of ASSIST publications, available on its website.

Report Author(s): 
Eds. Carl Bose and Jorge Hermida
USAID Applying Science to Strengthen and Improve Systems (ASSIST)/URC and American Academy of Pediatrics (AAP)
ASSIST publication: 
ASSIST publication
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