Assessing Quality of Neonatal, Maternal and Child Care in Niger

Introduction
The aim of this project is to support the Direction de la Santé de la Mere et de L'Enfant (DSME) to develop and implement a national health facility assessment of quality of maternal, newborn and child healthcare in Niger, in order to provide baseline information on quality of care, and to identify critical areas in need of improvement.

Brief background
Despite progress made in increasing the coverage of maternal and newborn health interventions over the past two decades, there is increasing recognition that further improvement in maternal and newborn health outcomes will depend on the ability to address the gap between coverage and quality. No nationwide assessment of quality of care in Niger has been done to date, although a pilot survey of five sites around the capital was completed in 2015 by the Ministry of Public Health. CMNH was tasked with revising the tools used for the national assessment, designing the study and then implementing it as part of partnership with Direction de la Santé de la Mere et de L'Enfant (DSME), Institute Nationale de la Statistique (INS) and University Research Co (URC).

Activities
To explore the quality of care in healthcare facilities in Niger, an assessment was undertaken covering antenatal, intrapartum, postnatal and paediatric care services by collecting data from healthcare facility registers and records, review of partographs, interviews with clients, observations of practice, assessment of knowledge of healthcare providers and focus group discussions with healthcare providers. Altogether, 14 separate tools were deployed in the survey. Data collection took place in a nationally representative sample of 110 facilities, including the national maternity hospital, regional hospital, Mother-Child hospitals, district hospitals and integrated health centres of type I and II, across all eight regions of the country.

Overall, this is a 12 month project; with 6 weeks of data collection (May-June 2018).

Outputs to date
With analysis ongoing, the plan is to provide the Ministry of Public Health with information at both national and regional levels, reflecting comprehensive findings of the survey using descriptive statistics as well as more focused quality of care assessment summarised using dashboards, which could be used to quickly evaluate key indicators.

The survey itself is a major achievement given its scale and complexity and conditions under which it was implemented. In particular, a team of 40 data collectors covered more than 15,000 kilometres during fieldwork, which was conducted in temperatures of 45 degrees centigrade with the additional hardship of working during Ramadan. Overall, they spoke to over 2,600 people (1,595 pregnant women and mothers, 914 healthcare providers and 110 managers), observed 461 consultations and analysed nearly 950 care records to help to understand various aspects of quality of services offered to women across the country in different types of healthcare facilities.