Advancing the Evidence-Base of the Minimum Initial Service Package (MISP) for Reproductive Health: Using a Quality Improvement Approach in DRC

Principal Investigator: Michelle Hynes, Centers for Disease Control and Prevention

Purpose

The research evaluated whether a participatory quality improvement (QI) intervention would improve the delivery of maternal and newborn health components of the MISP (Minimum Initial Service Package). The study was conducted in 12 health facilities in a protracted conflict in North Kivu, DRC; one of the first times that this QI approach had been used in a humanitarian setting.

The QI intervention consisted of training health staff members, with supportive coaching, to identify and test small changes within their facilities to improve the quality of maternal and newborn care. All facilities received clinical training at the start of the study period, with half the study facilities receiving the QI intervention during the study period, and the rest of the facilities receiving QI training after the study was completed. The research aimed to investigate the value added to a participatory QI process beyond the improvements seen after clinical training.

Methods

A longitudinal quasi-experimental mixed method was used with data collection methods including patient exit interviews, data extraction from maternity registers and partographs, patient care observations, and focus group discussions. Baseline and end line data were collected to assess the availability, utilisation, and quality of services.

Key Findings

• Results demonstrated significant impact of the QI approach on the provision of maternal and newborn care and the rate of improvement. The QI intervention group showed a greater rate of change than the control group for Active Management of the Third Stage of Labour(AMTSL) and achieved 100% Essential Newborn Care (ENC) completion at end line.
• Additional gains through the QI process included empowerment of staff, improved use of data, and strengthening supervisory relationships.
• The QI approach can be used effectively in humanitarian contexts. Lessons have been learnt about how the approach can be adapted when less training and supportive coaching are able to be provided than in non-humanitarian settings.

Key outputs

• Peer-reviewed article published on findings on two of the study outcomes: delivery of active management of the third stage of labour (AMTSL) and essential newborn care (ENC).
• Report on baseline evaluation published.
• Two further articles expected to be published, focusing on: accuracy of self-report measures; and respectful care as reported by women delivering in facilities.
• Findings presented at Inter-agency Working Group (IAWG) on Reproductive Health in Crises annual meeting (2017).
• Findings disseminated within DRC to Minister of Health and with stakeholders in Kinshasa and North Kivu.

IMC hoped to use research findings to influence future Quality Improvement programming in DRC and other countries.