7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
1/16
Respectful Maternity
Care: What to measure
and how to measure itEva Bazant, DrPH, MPH
Sr. MER Advisor, Jhpiego
Jennifer Huang, Jhpiego
FIGO Africa Regional Conference of
Gynecology and Obstetrics
Addis Ababa, Ethiopia
October 25, 2013
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
2/16
Outline
7 Domains of RMC
FIGO Code of Ethics
Disrespectful behavior among providers
Suggested indicators for RMC
Use of monitoring and evaluation (M&E)
Data sources
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
3/16
Consent
Confidential careNon-abandonment of care
No physical abuse
Dignified care
Equity in access
No abuse related to cost,including detention
Adapted from Bowser, D., Hill, K. 2010. Exploring evidence for disrespect
and abuse in facility-based childbirth: Report of a landscapeanalysis. Harvard School of Public Health University Research.
http://goo.gl/0NQ122 (Accessed Sept 22, 2013).
Respectful Maternity Care
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
4/16
Professionalism in health care of
women is the means by which
physicians provide ethical care thatrespects the sexual and reproductive
rights of women.
The FIGO, Code of Ethics
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
5/16
FIGO Medical Code of Ethics:
Guiding Principles
Ensure rights of persons to make
informed choices about their own
health care
Maximize the best health outcomes
Do no harm
Beneficence
Non-
maleficence
Autonomy
Distribute the burdens and benefitsof new or experimental treatments
equally among all groupsJustice
D E F I N I T I O NP R I N C I P L
E
Consent and information exchange
for informed decision-making,
confidential care
Dignified care, RMC as a larger part
of quality of care framework
Nophysicalabuse, ensures the
safety of women, Non-abandonment of care
Equity in access, No abuse related
to cost including detention
L I N K T O R M C
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
6/16
Respectful Maternity Care why
does it matter?
Reputation and Professionalism
Quality of Care
Patient Safety, Service Use and Health
Outcomes
Provider Satisfaction and Retention
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
7/16
Six Elements of Disrespect1. Disruptive behavior
2. Humiliating/demeaning
treatment of nurses,residents and students
3. Passive aggressive behavior
4. Passive disrespect
5. Dismissive treatment of
patients6. Systemic disrespect
Disrespect is a th reat to
patient safetybecause it
inhibits collegiality and
cooperation essential to
teamwork, cuts offcommunication,
undermines morale, and
inhibits compliance with
and implementationof newpractice.(Leape, et al. 2012)
Behavior
among Provider Teams
Leape, L. L., Shore, M. F., Dienstag, J. L., et al. 2012. A culture
of respect, part 1: The nature and causes of disrespectful
behavior by physicians.Academic Medicine, 87(7), 845-852.
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
8/16
Logic Model/M&E Framework
ContextInputs/
ActivitiesOutputs Outcomes Impact
Care after
Birth
ANC
Labor and
Delivery
7 RMC
DOMAINS
AfterBefore
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
9/16
Illustrative Indicators for RMC
Number of women who were asked theirpreferred birth position
Number of women who had a companionpresent in labor or delivery
Number of women able to explain the reason forreceiving a treatment for complication (cesareansection, episiotomy, etc.)
Number of women who were draped during
examinations Number of staff who rate the work environment
as respectful
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
10/16
Suggested Indicators for RMC
Number of women who were asked theirpreferred birth position
Number of women who had a companionpresent in labor or delivery
Number of women able to explain the reasonfor receiving a treatment for complication(cesarean section, episiotomy, etc.)
Number of women who were draped during
examinations Number of staff who rate the work environment
as respectful
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
11/16
Measuring the Indicator
Before and After
ContextInputs /
ActivitiesOutputs Outcomes Impact
Labor andDelivery
Number of
women able
to explain the
reason for
receiving a
treatment
AfterBefore
Protocol for
obtainingpatient
consent exists
Number of
providers
trained to
meet RMCcompetency
standards in
simulation Number of
women who
returned for
postnatal care(PNC)
Number of
clients
intending for
future birthsat the facility
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
12/16
What sources should be used
to collect data on RMC?
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
13/16
Data Sources
Data obtained from client or community
Exit interviews with clients
Companion interviews
Community interviews including community health management boardand focus groups
Formal evaluations
Document review
Facility readiness checklist
Training records and competency assessments
Supervision checklist
Labor & Delivery provider interviews Observation of labor and births (by 3rd party, trained observers or
supportive supervisor/mentor)
Service data from health information systems (HMIS) and registries
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
14/16
How can these data sources be
routine?
1. Include sources in the work plan and budget
2. Data collection by local organizations, local
universities, or facility community boards
3. Have short checklists and tools
4. Feedback via mobile phone data/SMS
(anonymity ensured by 3rd party)
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
15/16
Key Points
The 7 RMC domains align with the FIGO
Medical Code of Ethics
Listen to patients/clients AND providers
Select priority aspects of RMC for your
context and track indicators at the levels of
policy, outputs and outcomes
Consider data sources that can be maderoutine and collected within the budget
7/27/2019 Respectful Maternity Care: What to measure and how to measure it Powerpoint
16/16
Thank you!
Top Related