Restoring antenatal health services in a war-affected hospital: a quality improvement project.

Abstract

Background: Health service restoration involves reinstating all previous health service components to a facility after a period of disruption caused by war, conflict or other disasters. As defined by the WHO, antenatal care (ANC) is the care provided by skilled healthcare professionals to pregnant women and adolescent girls to ensure optimal health conditions for both mother and fetus during pregnancy. Before the restoration process, the hospital senior management team, maternal and newborn health (MNH) staff and Institute for Healthcare Improvement (IHI) improvement advisors had discussions on how to restore ANC services. This quality improvement (QI) project aims to restore ANC service at the war-damaged hospital, Amhara region, Ethiopia.

Methods: The model for improvement method was applied, we collected 6 months of data retrospectively to form a baseline, 1-year data were collected during implementation and a second year's data to ensure sustainability of improvement.

Result: The run chart shows the percentage of pregnant mothers who received all ANC bundle elements at their first ANC visit at Jamma Primary Hospital and improved from a baseline of 0% to 94.5%.

Conclusion: The project involved three interventions that worked well: using the ANC first bundle checklist, conducting exit interviews with pregnant women and checking laboratory test availability every week. Additionally, through our Plan-Do-Study-Act, we understood that engaging the community in our QI project and providing psychosocial support for healthcare providers after the conflict were helpful in improving our QI project.