International Journal for Quality in Health Care, 2021, 33(1), 1–9 doi: 10.1093/intqhc/mzab028 Advance Access Publication Date: 23 February 2021 Original Research Article Original Research Article Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool EMANUELLE PESSA VALENTE 1 , FABIO BARBONE 2 , TEREZA REBECCA DE MELO E LIMA 3,4 , PAULA FERDINANDA CONCEIÇÃO DE MASCENA DINIZ MAIA 4,5 , FRANCESCA VEZZINI 3,6 , and GIORGIO TAMBURLINI 6,7 1 WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell’Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy, 2 Scientifc Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell’Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy, 3 Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fer- nando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil, 4 Medicine course department, Faculdade Pernambucana de Saúde (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil, 5 Pediatric department, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitària, Recife - Pernambuco 50670-901, Brazil, 6 Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Università degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy, and 7 Director, Centro per la Salute del Bambino, Via Nocolò de Rin, 19, Trieste, Friuli Venezia Giulia Region 34143, Italy Address reprint requests to: Emanuelle Pessa Valente, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS ‘Burlo Garofolo’, Via dell’Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy. Tel: +39 040 3785642; E-mail: emanuelle.pessavalente@burlo.trieste.it Received 2 October 2020; Editorial Decision 13 February 2021; Revised 9 February 2021; Accepted 20 February 2021 Abstract Background: Increasing efforts toward quality improvement (QI) are necessary in low- and middle- income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. Objectives: We assessed the effects of a 1-year comprehensive QI cycle using a World Health Orga- nization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. Methods: Uncontrolled, unblinded, pre–post study carried out in six maternity hospitals in Pernam- buco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hos- pital level was used. A national team of assessors supervised by international experts carried out baseline and fnal assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. Results: At baseline, hospitals presented a variety of quality gaps, the majority common to all par- ticipating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Downloaded from https://academic.oup.com/intqhc/article/33/1/mzab028/6146808 by guest on 10 June 2022