By Uma Govindswamy
November, as a part of the Center for Global Health’s Reproductive Health in Africa Speaker Series, sponsored by the Africa Initiative, Dr. Joy Noel Baumgartner and Dr. Rohit Ramaswamy lectured on the topic: Evaluating Quality in Maternal Health Interventions. Dr. Joy Noel Baumgartner is the Director of the DGHI Evidence Lab, the lead of the DGHI Global Mental Health Working Group, and a professor here at Duke University. She has been an active public health practitioner and researcher for over 20 years and has worked in countries such as Cameroon, Kenya, India, South Africa, Jamaica, Tanzania, Ghana, and Uganda. Dr. Rohit Ramaswamy is Director of the Center for Global Learning and a Professor in the Department of Maternal and Child Health at UNC’s Gillings School of Global Public Health. His past research has focused on implementing delivery systems that improve the quality of healthcare for women in low-resource settings including India, Ghana, Nigeria, and Uganda, to name a few.
Dr. Baumgartner began the presentations with an evaluation of the LifeNet quality of care training program on maternal and child health in Uganda. She discussed the limitations of medical records (with particular reference to time-sensitive actions), the impact of perinatal depression, and the necessity for integrating mental health services into maternal health services. Dr. Ramaswamy then continued by discussing a multi-tiered quality improvement strategy to reduce maternal and newborn deaths in complex delivery systems in Ghana. He discussed the necessity for a multi-faceted implementation process including developing change agents, building a foundational capacity in QI and research, identifying clinical and operational gaps in each step of the process, building clinical capacity to close those gaps, assessing learning and performance, and using rapid implementation cycles to continuously improve. He presented this framework through the example of hand washing and hygiene at the clinic in order to reduce the risk of spread of disease or illness in the context of maternal and newborn health.
Both Dr. Baumgartner and Dr. Ramaswamy stressed the importance of monitoring and evaluating quality of care in the context of maternal and child health. Their implementation strategies differed significantly – with Dr. Baumgartner’s focusing moreso on integrating maternal and mental health to improve both maternal and child health outcomes, whereas Dr. Ramaswamy moreso focused on the need for a systemic overhaul through a multi-faceted approach to close all the gaps in care continuously arising. Their approaches are both focused on long term systemic change to strengthen healthcare security networks for women and children, which is extremely important to begin to address now in the context of maternal and child health.