On 17th October 2018, a team from The Centre for Maternal and Newborn Health (CMNH) presented at a dissemination workshop at the Ministry of Public Health in Niamey, Niger. The event gave Professor Monir Islam, Dr Alexandre Quach and Dr Barbara Madaj the opportunity to share the results of our extensive national survey of quality of care for maternal, newborn and child care in healthcare facilities across the country.
Over 60 participants attended, including representatives from various authorities and divisions of the Ministry of Public Health, academia, health services, national and international organisations and bilateral donors (including WHO, UNICEF, UNFPA, USAID, GAVI), professional bodies, as well as partners (Global Fund, Department of Mother and Child Health (Direction de la Santé Mère-Enfant, DSME), the National Institute for Statistics (Institut National de la Statistique, INS) and Save the Children International). The presentation captured the audience and created a great platform for discussion of individual results but also more broadly on aspects of care relating to quality of care provision.
This national study is the first of its kind, and covers the whole spectrum of the continuum of care including antenatal, intrapartum and emergency obstetric care, postpartum, and paediatric care services. It has therefore generated much needed evidence to understand the situation of healthcare facilities in Niger, with regard to the availability and quality of care offered to mothers and babies. Data was collected using a wide range of tools, including a review of facility registers and records, observation of care and interviews with clients, knowledge test of healthcare providers, and focus group discussions and interviews with healthcare providers. This enabled CMNH researchers to create a comprehensive picture of the situation in the healthcare facilities and identify examples of excellent quality as well as key areas for improvement.
Some examples of key findings revealed by the survey include:
- Although the majority of healthcare facilities have access to basic infrastructure, there are gaps around transport, which require attention to ensure services can be provided. For example, in Agadez region - although 100% of facilities will have access to transport for referrals, only 6% of health centres have dedicated transport within the facilities.
- Similarly, the availability of equipment, medications and consumables varies. Some aspects were exemplary: for example, antibiotics, uterotonics and antihypertensives were found to be available in over 80% of facilities, but there are concerns about the availability of resuscitation equipment for newborns across most regions.
- For antenatal care services, 100% of health centres were found to provide the service and over 80% have the necessary national guidelines for the service provision. However, only 15% and 22% of women are tested for syphilis and anaemia respectively, which are the basic standard tests to be done as part of the care.
- The data also confirms high levels of maternal mortality, but it is encouraging to see that most facilities of higher level (three-quarters) engage actively in maternal death reviews.
- Despite recognising gaps in their working environment, healthcare providers show much support for engaging in improving service provision.
- From the perspective of clients, there were great practices in terms of women feeling their privacy was being respected and reporting not being abused. However, some gaps around communication were raised with regard to clarifications of examinations done or having questions answered.
Dr Monir Islam, Dr Alexandre Quach and Dr Barbara Madaj shared their thoughts following the workshop:
“We are very grateful for having been entrusted with such an important study and for the opportunity to work in Niger. It would not have been possible to complete the work without the immense effort and dedication from all the partners.
In particular, we would like to thank the Ministry for their overall guidance, DSME for their technical support, INS for the support on the data collection and organisation of the survey, URC for the quality assurance support, representatives of the national and international organisations for their inputs into the design and tool review, the Ethics Committee for their patronage over the research aspect, the data collectors and supervisors who went above and beyond to collect the data under the challenging field conditions, all those at the selected healthcare facilities who gave up their time to provide the necessary information, as well as all of the women who shared their experiences to provide a complete picture regarding services offered. Finally, our thanks go to The Global Fund to Fight AIDS, Tuberculosis and Malaria for their generous support and Save the Children for their support on the ground in managing the study.
We are very pleased with the outcome of the survey and the response it has evoked from those present at the meeting and beyond. The complexity and size of the assessment required much effort in terms of preparations and execution of the work. To have the final product ready means the Ministry as well as the partners working on the ground have a reference baseline of robust data that can be used for planning and policy making.
We hope to be able to return to Niger soon, but in the meantime, we hope that the survey serves as a useful reference for continued discussions on the topic and helps to provide the required information for planning activities to continue to improve the quality of care of services in Niger.”