Improving paediatric quality of care at first-level referral hospitals
Final meeting on the WHO-Russian Federation paediatric quality of care improvement initiative, Geneva, Switzerland, 27–28 July 2015
Major gaps exist in many health facilities between evidence-based standards of care and the actual quality of services that are provided. In responding to this challenge, WHO has been working with countries to improve the quality of paediatric care in the district hospitals, building upon evidence and practical experiences. This have proven successful where introduction of national paediatric standards of care and institutionalization of triage and emergency paediatric care procedures resulted in a reduction in case fatality.
In an effort to scale up and document best practices, the Russian Federation funded a US$ 3.7 million 3 year collaborative tripartite initiative with WHO and the governments of Angola, Ethiopia, Kyrgyzstan and Tajikistan to improve the quality of paediatric care in hospitals. Within the framework of this initiative, technical assistance was provided to the four countries to strengthen their national health systems' capacity to improve the quality of paediatric care.
This report reflects the proceedings from a meeting held 27–28 July 2015 in Geneva, Switzerland, bringing together the 4 implementing countries, experts who provided support, WHO staff and the representatives from the Russian Federation as the donor. The purpose of the meeting was to report on the results and achievements of the initiative and discuss the broader strategic coordinated action in the context of women’s and children’s health.
The initiative supported institutionalization of the concept of quality of care, development of national paediatric guidelines and standards care, capacity building for health workers, development of tools, and implementation of quality improvement activities. The initiative was implemented across 51 selected hospitals in the 4 countries and evaluation after 3 years of implementation showed an overall improvement in quality of care with a decline in case fatality and a trend towards a reduction in child hospital deaths rates. There were improvements in the case management of diarrhoea, pneumonia, malaria, febrile conditions, severe acute malnutrition and newborn conditions (routine care, asphyxia, preterm and small babies care, and neonatal infections). There was tremendous improvement in the rational use of medicines, especially in the central Asian countries, with a significant reduction in polypharmacy and unnecessary use of infusions or injections compared with baseline.