Improving quality for maternal care - a case study from Kerala, India
Ioana Vlad1, V P Paily2, Rajeev Sadanandan3
1London School of Hygiene and Tropical Medicine, London, UK.
F1000Research
|July 22, 2016
Summary
Developing evidence-informed quality standards (QS) in Kerala, India, successfully addressed the maternal mortality gap. Local adaptation and multi-stakeholder involvement were key to implementing these crucial maternal health guidelines.
Area of Science:
- Maternal Health
- Healthcare Quality Improvement
- Public Health Policy
Background:
- Maternal health guideline implementation remains a challenge, even for established interventions.
- Improving the quality of care in health facilities is crucial for preventing maternal mortality, particularly in regions like Kerala, India.
- Evidence-informed quality standards (QS) offer an innovative approach to bridge the gap in guideline implementation.
Purpose of the Study:
- To develop and implement the first clinical quality standards (QS) in Kerala, India, aimed at reducing maternal mortality.
- To adapt the NICE QS development framework to the local context of Kerala, ensuring local ownership and relevance.
- To address post-partum haemorrhage, identified as the leading cause of maternal death in the region.
Main Methods:
- Adapted the NICE QS development framework with a focus on local ownership.
- Established a multidisciplinary group including policymakers, clinicians, and administrators.
- Conducted multi-stakeholder workshops to ensure relevance and acceptability of QS statements and indicators derived from global and local guidelines.
- Identified practical implementation and monitoring strategies.
Main Results:
- Successfully developed and initiated the implementation of clinical QS for reducing maternal mortality in Kerala.
- Post-partum haemorrhage was identified as the priority area for QS development based on local evidence.
- The process ensured that the developed QS were relevant and acceptable to local clinicians and policymakers.
Conclusions:
- A strong evidence base and an inclusive development process are equally vital for successful QS development.
- A principle-based approach is recommended for countries adapting global evidence to local contexts, rather than a one-size-fits-all model.
- The Kerala initiative demonstrates a successful model for adapting and implementing evidence-informed quality standards in maternal healthcare.
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