Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis

Sureka Pavalagantharajah; Atziri Ramirez Negrin; Katrina Bouzanis; Tin-Suet Joan Lee; Peter Miller; Rebecca Jones; Will Sinnott; Elizabeth Alvarez

doi:10.1007/s10995-023-03702-8

Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis

Matern Child Health J. 2023 Oct;27(10):1742-1753. doi: 10.1007/s10995-023-03702-8. Epub 2023 Jul 7.

Authors

Sureka Pavalagantharajah¹, Atziri Ramirez Negrin², Katrina Bouzanis³, Tin-Suet Joan Lee⁴, Peter Miller⁵, Rebecca Jones⁶, Will Sinnott⁷, Elizabeth Alvarez⁸

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
² Department of Gynecology, Hospital Dr. Manuel Gea Gonzalez, Mexico City, Mexico.
³ Department of Global Health, McMaster University, Hamilton, ON, Canada.
⁴ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Faculty of Science, McMaster University, Hamilton, ON, Canada.
⁶ Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. alvare@mcmaster.ca.

PMID: 37418097
DOI: 10.1007/s10995-023-03702-8

Abstract

Objectives: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level.

Methods: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer.

Results: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.

Keywords: Quality of care; maternal health; maternal morbidity; maternal mortality; obstetric care.

Plain language summary

Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care.

Publication types

Systematic Review
Review

MeSH terms

Female
Humans
Maternal Health Services*
Pregnancy
Quality of Health Care