This report presents results from a health facility survey conducted to support and generate evidence for the impact evaluation of the Kyrgyz Performance-Based Payments project. Global evidence suggests that improving the quality of obstetric care can directly reduce maternal and neonatal deaths. Most maternal deaths are caused by obstetric complications, including postpartum hemorrhage (PPH), obstructed labor, pre-eclampsia/eclampsia (PE/E), puerperal sepsis, and complications of unsafe abortion. The majority of neonatal deaths result from infections, birth asphyxia, birth trauma, or complications of prematurity.
The main objective of this Quality of Care (QoC) survey is to serve as a baseline to evaluate the effectiveness of a performance-based payments scheme to improve the quality of maternal and neonatal health services in Kyrgyz Republic. The primary outcome measures for the survey were overall facility readiness, particularly with regards to complicated labor and delivery, quality of antenatal care (ANC), quality of labor and delivery (L&D), infection control, management of complications of labor and delivery (PPH, severe PE/E, obstructed labor), essential newborn care, newborn resuscitation, harmful health practices, and health worker knowledge.
The study was conducted in all 65 secondary hospitals in the Kyrgyz Republic, most of which had corresponding primary health care clinics. The 65 hospitals were the main focus of the quality of care survey for maternal and neonatal health while on-site primary care clinics were included in the sample to assess the availability and quality of ANC services. Six tools were used to gather data and observations during health facility visits: a health facility assessment, health worker interviews/ knowledge tests, observations of labor and delivery and ante natal care visits, patient interviews, simulations of neonatal asphyxia and PPH using NeoNatalie and MamaNatalie anatomical models, and criterion based clinical audits (i.e., review of patient records against WHO-established clinical standards of care). This report presents key findings from the first six of these tools.
Baseline survey data focusing on quality of care measures was collected in the first quarter of 2013.
This summary report is based on the baseline survey of the impact evaluation of the Kyrgyz Republic Performance-Based Payments for Maternal and Neonatal Health project. The baseline survey was designed to capture the status of the health system in Kyrgyz prior to the start of the project. As such, this survey and the corresponding report are the foundation/starting point for the prospective impact evaluation which is currently underway. While this report is intended to provide a snapshot of the Kyrgyz health system in 2013, it should not be viewed as an assessment of that health system. These findings are part of work in progress and are disseminated to encourage the exchange of ideas about health issues in developing countries. The reports carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. This report is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. The authors may be contacted at firstname.lastname@example.org.