Background
Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes through effective, safe and people-centred care that responds to individual preferences, needs, and values. To realize the benefits of quality in MNH, the quality of healthcare services ought to be timely, equitable, integrated, and efficient. Healthcare providers require competencies for integrating quality assessment for continuous improvement of the services they provide. As countries commit to achieving Health for All by the year 2030, it is necessary to consider the quality of care and health services provided to mothers and newborns throughout the continuum of pregnancy and childbirth.
Healthcare providers require skills to conduct the root cause analysis of priority clinical problems that may have resulted in preventable morbidities and/or mortalities. Quality assessment skills are required urgently particularly in low- and middle-income countries that bear the greatest burden of preventable maternal and perinatal mortalities and still births. Maternal and newborn healthcare needs to be of increasingly higher standard in order to ensure continuous improvement of health outcomes. The LSTM quality improvement (QI) course provides healthcare workers with the necessary tools to evaluate and improve the quality of care provided using standards-based audit.
Methods
To make the course accessible to as many health providers as possible and to be cost-effective, the existing QI course was modified to use a blended learning approach, a format that has been found to work well previously (1). This comprised Self-directed learning (SDL) using the WCEA online platform, online group learning (zoom sessions), and face-to-face (F2F) group learning. Material from the previous synchronous QI course was used as a foundation for the new blended learning course. Using an Excel matrix, each content was allocated to the pedagogic approach most appropriate, ensuring adequate coverage and avoiding unnecessary duplication. The course presentations and support materials were developed, reviewed, and recorded by members of the team. A participant workbook containing templates and work examples and a detailed facilitators’ manual were developed.
Once finalised, the package was piloted, and clarifications did on WCEA. Online orientations were conducted to familiarise existing course facilitators to the new package. A master trainer package was developed for new facilitators not familiar with the online QI training approach. The participants get to learn about using standard based audit cycle to implement clinical change management for quality-of-care improvement. The clinical standards are country specific for antenatal care, intrapartum care, and post-partum care improvement.
This course has been piloted with 58 facilitators trained from Kenya, Nigeria, and Tanzania. Over 300 healthcare providers have completed the SDL modules, online facilitated sessions, and face to face practical sessions. Participants’ feedback indicated the usefulness of a blended learning approach scoring SDL modules a 4 or 5 out of 5. Participants also found the blended learning modules on WCEA flexible and requested similar courses in the future.
Conclusion and recommendations
The QI blended learning course is well received, allowing large numbers of participants to access the learning materials from WCEA than would have been possible using the traditional face to face learning model. An increased investment is required to support blended learning programs for in-service health workers in low- and middle-income countries for continuous professional development and learning. The expected outcome is an improvement in the quality of healthcare services offered to women and newborns and an accelerated annual rate of reduction of preventable maternal and neonatal mortality and stillbirths.
1. Ladur et al, 2023. https://www.medrxiv.org/content/10.1101/2023.05.04.23289508v1
