does quality improvement become part of the routine, ongoing process of
providing abortion-related care? At Ipas-supported training and service
delivery sites around the world, that question is getting special
attention—and the effort already is translating into better care for
women in some of the world’s most remote and impoverished areas.
A recent example comes from Ethiopia, where Ipas has provided
training to health officials on how to monitor and improve quality of
care. A quality-improvement team visiting a hospital noticed that a
young health officer was not using the latest recommended dosage regimen
for second-trimester medical abortion. They gave him a copy of the most up-to-date, evidence-based clinical guidance,
which he reviewed overnight. Two days later he reported that he had
implemented the new regimen with a woman at the hospital and that it had
worked well. And most important, the woman had been able to leave the
hospital and return to her family several hours earlier than she would
have with the dosage regimen he had been using previously.
That site visit was part of an Ipas monitoring program that offers
technical assistance on quality improvement to Ipas-supported facilities
in Africa, Asia and Latin America. “It’s not about arriving with a
checklist and finding fault,” says Ipas Senior Clinical Advisor Bill
Powell. “We’re there to hear from providers and clinic staff about
barriers, challenges and ideas for local solutions, provide up-to-date
clinical guidance, and learn about promising practices and support
providers.” It’s a collaborative process, he says, aimed at improving
care for women.
Ideally, each site visit includes
observation of uterine evacuation services, with the permission of the
client and provider. The visiting team—made up of Ipas Clinical Affairs
and in-country Health Systems advisors—also looks at logbooks and goes
over clinical questions with providers and facility managers. They
discuss issues including:
- pain management
- offering a range of contraceptive methods
- expanding choice for women by offering medical abortion
- putting the latest clinical evidence into practice
- making services more accessible and responsive to young women.
The program and trainings emphasize that
improving quality is closely linked to creating a “safety culture.”
Providers and facility managers are encouraged to view cases where
complications arise—including serious adverse events—not as a time to
point fingers and cast blame, but as a chance to learn and to improve
future care.
Powell recalls an incident in a remote
area of Nepal, where an auxiliary nurse midwife at a health post
provided a medical abortion for a woman in the community. The woman
experienced severe complications. Bleeding heavily and in shock, she was
admitted to a larger district hospital, where a doctor provided her
with life-saving care. In that area of Nepal, Powell notes, there was a
good chance the nurse would be accosted by angry family and community
members, possibly leading to the discontinuation of abortion services at
that health post. The doctor who had treated the complications,
however, helped to diffuse the situation by making a point of meeting
with the nurse, her administrator and community leaders. He reviewed the
case with the nurse, and talked with the health post administrator and
community leaders about the importance of the nurse’s work in providing
safe abortion care.
“The doctor acknowledged that
complications, though rare, do occur. His willingness to meet with the
community and share that information helped to prevent abortion services
from being cut off in that community,” says Powell. “That is a prime
example of creating a safety culture.”
Dr. Deeb Shrestha Dangol, an ob-gyn and
Senior Program Advisor for Ipas Nepal, notes that the doctor in that
instance had received orientation on serious adverse events from Ipas
Nepal at a provider network meeting. “The ‘no-blame’ approach is really
important. We do orientations at the facility level and with
stakeholders in the district, so that providers can feel supported and
will continue providing services,” she says.
As Tibebu Aleymayehu, Ipas Senior
Program Advisor, adds: “What these stories show is that partnership is
the most important aspect of the monitoring program—whether it’s with
communities, providers, or trainers—and that improving quality makes a
real difference in women’s lives.”
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