Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool

Abstract Background Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal perinatal mortality morbidity promote respectful care. In Brazil, health indicators below targets several states despite universal access services very high rates of institutional births, indicating poor care (QoC) as a key issue be addressed. However, research develop test QoC interventions scarce. Objectives We assessed the effects 1-year comprehensive QI cycle using World Health Organization (WHO) assessment tool on newborn at hospital level documented QIs obtained after cycle. Methods Uncontrolled, unblinded, pre–post study carried out six maternity hospitals Pernambuco, accounting for 29 128 live births 2014. A standards-based participatory approach based WHO neonatal was used. national team assessors supervised by international experts baseline final assessments. An action plan developed implemented address gaps emerging from two supportive supervision visits. Results At baseline, presented variety gaps, majority common all participating centers. Gaps case management normal complicated deliveries holistic were predominant, both teaching/tertiary secondary hospitals. After one year, improvements observed, particularly during labor delivery, delivery Conclusions systematic produced important relatively short time should considered use large-scale programs Brazil other LMICs. Its comprehensive, peer-to-peer action-oriented nature its capability document over build culture represent comparative advantages interventions.