Assessment of the safety and quality of hospital care
for mothers and newborn babies in Montenegro
Ensuring adequate quality of care (QoC) is a primary objective of Health 2020, the European strategic framework drawing the policy directions for the 53 member states in the WHO European Region (5). Adequate QoC is recognized as essential for the health and well-being of the population, but also as a basic aspect of human rights (6,7). Evidence suggests that coverage of essential intervention does not ensure adequate health outcomes, without broader consideration given to the QoC aspects (10-14). At facility level, poor QoC is a major contributor to avoidable maternal and neonatal mortality and morbidity. A first mission for evaluating QoC in selected maternities in Montenegro was organized in 2011. In 2016, the Ministry of Health (MOH), in partnership with the UNICEF Country Office Montenegro, with the technical support of the WHO Collaborating Centre (WHO CC) in Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste, Italy, organized a second mission with the following objectives: a. assess progress made since the previous WHO assessment in 2011 and identify remaining critical issues concerning the quality of maternal and newborn care in selected hospitals in Montenegro; b. suggest further actions needed to improve quality of maternal and newborn care at facility level, taking into account each underlying factor influencing the quality of care; c. provide the opportunity for a national team of assessors to become familiar with the assessment tools and methods. The assessment was also meant as a way of introducing managers and health professionals to the concept of peer review and quality improvement in hospitals. The mission was held in between 18 and 27 January 2016. Only 3 maternities were selected for this assessment (National Clinical Centre in Podgorica, General Hospital of Berane, General Hospital of Nikšić) therefore the results of this assessment cannot be generalized to the overall quality of care in all maternities in Montenegro. The methods of the mission followed the standard WHO methodology. The main tool used was the WHO Hospital care for mothers and newborn babies: quality assessment and improvement tool” World Health Organization. This tool allows for a systematic assessment of all different domains relevant to the final QoC provided at hospital level. More specifically, the WHO tool includes the following domains: physical structure; staffing and basic services; statistics, health management information system and medical records; pharmacy management and medicine availability; equipment and supplies; laboratory support; ward infrastructures, case management (normal labour and vaginal birth, caesarean section, maternal complications and emergencies, routine neonatal care, sick newborn care, advanced newborn care), monitoring and follow-up; policies and organization of services; infection prevention; guidelines and audit; access to hospital care and continuity of care; mother and newborn rights. The evaluation pointed out good progress in respect to the previous assessment held in year 2011:
- A National Group for Perinatal Care started to exist, and members of the group participated to this assessment.
- Currently in the assessed maternities there are good physical structures (water, electricity and heating) and good hygiene.
- In some labour wards equipment has been replaced and renovated: delivery beds, overhead heaters, newborn resuscitation equipment. In most units equipment is fairly new and in good working order.
- Episiotomy doesn’t appear to be routinely practiced any more.
- Many outdated procedures have been dismissed, for example the routine aspiration of amniotic fluid for normal births and immediate cord clamping. Cord is now clamped and cut after the first minute of life
- Skin to skin contact is practiced and breastfeeding is facilitated, although it could be improved trough “rooming-in”.
- There are good team dynamics, and dedicated staff.