Proposal to Introduce a Quality Improvement Project in Armenian Maternity Hospitals

Abstract

Executive summary Since achieving independence in September 1991, Armenia has faced enormous difficulties in different spheres, including health care. Nevertheless, the country is becoming increasingly engaged in reforming the health system. Among various health spheres, Maternal and Child Health (MCH) has always been a top priority and has strategic importance for the country. Poor access to and insufficient quality of MCH services are of particular concern in Armenia. For many of the reproductive health and MCH indicators, Armenia is still far below average European levels. The Ministry of Health (MoH) and international organizations have undertaken efforts to improve the quality of MCH, but the need for continuous improvement remains. The local non-governmental organization “Future Generation” has proposed a two-year pilot project aiming to introduce quality improvement (QI) approaches and improve maternal and newborn health (MNH) care in five Armenian maternities. “Future Generations” aims to improve MNH indicators by introducing hospital based data collection, supporting data analysis, and identify centers demonstrating best practices. Best practices will be determined by an analysis of relevant indicators, including incidence of postpartum hemorrhage, registration of pregnant women, and initiation of breastfeeding. A quality improvement working group will be established in each maternity which will be responsible for overall QI activities. The budget of the proposed project is 372, 257 US$. Evaluation of the project will utilize a quasi-experimental, two-group, pre-test/post-test study design. Six objectives will be measured. The project will strive to: 1) increase early registration of pregnant women by 10%; 2) increase the number of women having at least four antenatal care visits by 10%; 3) increase the number of infants who are breastfed within the 1st hour after delivery by 10%; and 4) decrease postpartum hemorrhage incidence by 3%, compared with baseline data. In addition, five project-supported maternities will be established with functioning health information systems with at least 10 trained QI managers. Moreover, a qualitative study on patient satisfaction will be conducted in the project-supported and control maternities. If the project is successful it can be adopted by the MOH and implemented in all MCH facilities throughout Armenia.