RT Journal Article
SR Electronic
T1 Effectiveness of Capacity-Building and Quality Improvement Interventions to Improve Day-of-Birth Care in Kinshasa, Democratic Republic of the Congo
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2300236
DO 10.9745/GHSP-D-23-00236
VO 12
IS 1
A1 Kikaya, Virgile
A1 Katembwe, Fernand
A1 Yabili, Jacky
A1 Mbwanya, Marcel
A1 Dhuse, Elana
A1 Gomez, Patricia
A1 Waxman, Rachel
A1 Mohan, Diwakar
A1 Tappis, Hannah
YR 2024
UL http://www.ghspjournal.org/content/12/1/e2300236.abstract
AB Key FindingsThis study of 16 health facilities providing maternity care in Kinshasa, DRC, suggests that a low-dose, high-frequency capacity-building approach coupled with continuous mentoring and quality improvement interventions is effective in changing provider performance and improving quality of care and outcomes.Early neonatal death rates significantly decreased by 9% across all facilities, and client satisfaction, as measured by the mean person-centered maternity care score, improved by 58%.At 12 months post-training, at least 75% of providers across all 16 facilities demonstrated competency in key skills around the day of birth. More than 80% demonstrated competency in the treatment of incomplete abortion and more than 90% in contraceptive implant insertion.Key ImplicationsUse of integrated low-dose, high-frequency training sessions in combination with mentoring and quality improvement methods should be considered in both in-service training and preservice education.Close collaboration with the National Program for Reproductive Health of the Ministry of Health, including training of national trainers, provides a foundation for local ownership, sustainability, and its validation as an approved approach to conduct in-service capacity-building of providers.In sub-Saharan African settings like the Democratic Republic of the Congo, high-quality care during childbirth and the immediate postpartum period is lacking in public facilities, necessitating multipronged interventions to improve care. We used a pre-post design to examine the effectiveness of a low-dose, high-frequency capacity-building and quality improvement (QI) intervention to improve care for women and newborns around the day of birth in 16 health facilities in Kinshasa, Democratic Republic of the Congo. Effectiveness was assessed based on changes in provider skills, key health indicators, and beneficiary satisfaction. To assess changes in the competency of the 188 providers participating in the intervention, we conducted objective structured clinical examinations on care for mothers and newborns on the day of birth, immediate postpartum family planning (PPFP) counseling and method provision, and postabortion care before and after implementation of training and at 6 and 12 months after training. Interrupted time series (ITS) analysis techniques were used to analyze routine health service data for changes in select maternal, newborn, and postpartum outcomes before and after the intervention. To assess changes in clients’ perceptions of care, 2 rounds of telephone surveys were administered. Before the intervention, less than 2% of participating providers demonstrated competency in skills. Immediately after training, more than 80% demonstrated competency, and 70% retained competency after 12 months. ITS analyses show the risk of early neonatal death declined significantly by 9% (95% confidence interval [CI]=4%, 13%, P<.001), and likelihood of immediate PPFP uptake increased significantly by 72% (95% CI=53%, 92%, P<.001). Client satisfaction improved by 58% over the life of the project. These findings build on previous studies documenting the effectiveness of clinical capacity-building and QI approaches. If implemented at scale, this approach has the potential to substantively contribute to improving maternal and perinatal health in similar settings.