Afghanistan national maternal and newborn health quality of care assessment 2016
Key finding report
The 2016 National Maternal and Newborn Health Quality of Care Assessment is the first large-scale study in Afghanistan to examine the quality of both routine and emergency maternal and newborn health services in terms of compliance with global clinical practice standards as well as the manner and environment in which care is provided. It was designed to generate information to guide efforts for reducing preventable maternal and newborn mortality and morbidity in Afghanistan.
The assessment is a cross-sectional national facility survey, using a mix of rigorous quantitative and qualitative methods to assess health facility readiness for routine and emergency maternal and newborn service provision, as well as the quality of antenatal care, labor and delivery care, early postnatal care (inpatient care before discharge from a facility after childbirth), and management of select obstetric and newborn complications. Data collection was conducted by a team of 32 skilled birth attendants (SBAs) between May 14, 2016, and January 5, 2017. Data collection teams visited 246 health facilities including five Specialized Hospitals, five Regional Hospitals, 27 Provincial Hospitals, 45 District Hospitals, 33 Comprehensive Health Centers, 60 Basic Health Centers, 42 Sub-Health Centers, 10 Family Health Houses, and 20 private hospitals or clinics. Data collection methods included health facility inventories and record reviews, interviews with SBAs, and observations of antenatal, intrapartum, and early postnatal care.
The Key Findings section of this report provides a summary of quantitative indicators of maternal and newborn health service readiness and quality of care at public facilities in Afghanistan. Detailed results are presented for public and private facilities in Appendix 2. Overall, the results show that while most facilities have the drugs and supplies needed for routine and emergency maternal and newborn care, and family planning, many women are receiving poor quality and disrespectful care. There are many concerning gaps in the provision of antenatal, intrapartum, and postnatal care for women and newborns. These gaps include a number of relatively simple practices that can substantially reduce the risk of mortality such as administration of a uterotonic immediately after delivery, skin-to-skin contact for newborns immediately after birth, support for women to breastfeed in the first hour after birth, and regular handwashing by health care providers. In addition to gaps in evidence-based practices, a number of unindicated and potentially harmful practices were documented during observations of labor and delivery. Finally, effective communication with women and their families was also a weak area; too few women received explanations of what their health care provider was doing during antenatal, intrapartum, and postpartum examinations.
Interviews with SBAs revealed substantial knowledge gaps related to prevention, detection, and management of obstetric and newborn complications. The marginal gap in knowledge and implementation of key evidence-based practices suggests that when SBAs know what needs to be done to address maternal and newborn complications, they are providing this care. This finding points to the need for targeted efforts to strengthen health worker capacity, with a focus on evidence-based practices for prevention, detection, and management of complications, as well as strengthened documentation, tracking, and accountability for a core set of indicators focused on client-centered care and high-impact interventions for maternal and newborn survival. Assumptions that all women receiving antenatal care or giving birth at a facility receive the same information and evidence-based interventions should be challenged, and facility staff should be supported to ensure a high standard of care for all clients that promotes respect for women’s values, rights, and role in their own care.