JMIR Publications

ABSTRACT

Background:

Audit and review systems especially with community engagement are key elements in achieving improved health system performance, maternal and perinatal health outcomes. This protocol describes an implementation approach guiding scale-up and presents a proposed mixed-methods evaluation plan.

Objective:

To develop a locally relevant and reliable audit system and evaluate its feasibility within the rural Pakistan health system.

Methods:

A mixed-methods approach will be used to evaluate implementation through six implementation phases; I: Identify facility and community leadership, II: Establish Audit Committee, III: Initiate Audit with ongoing Community Engagement, IV: Train the Audit Committees, V: Launching the Audit Cycle (monthly meetings), VI: Quarterly review and refresher training of Audit Committee members. Data from all deliveries, livebirths, maternal deaths, maternal near misses, stillbirths, and neonatal deaths will be identified and recorded from three rural health facilities, Lady Health Workers’ (LHWs) registers, community representatives and the project team. Data drawn from case assessments, routinely collected process and analysis and recommendations components using iterative improvement cycles during the projection. Outcomes will be measured through data collection tools including distribution of mortality by locations of death, proportion of facilities who implemented audit system, proportion of audit committees with community representation, proportion of community audit members sharing feedback regularly, referral mechanisms, transport mechanisms, improved quality of maternal and newborn service delivery in secondary care health facilities. Descriptive statistics will be used to categorize the outcomes on the ‘Three Delay’s Framework’. Results will be summarized in frequency and percentage changes during the implementation phase of the audit intervention. Data will be analyzed using STAT v.16.

Results:

The study received approval from the Aga Khan University Ethical Review Committee of [ERC number 2021-6426-19638]. Results will be shared anonymously, at the quarterly District Health Program Management Team Meetings (DHPMT).

Conclusions:

This project will link district health administration personnel, facility-based health care providers including Lady Health Supervisor (LHS), gynecologist, pediatrician, and medical officers and most importantly community representatives. Further, this will identify problems in the community and health facility that may have contributed to stillbirths and neonatal deaths, maternal deaths and maternal near miss cases, especially those that could have been prevented. Audit committees analyze the information and propose recommendations in facility-based meetings. The doable recommendations will be implemented in the context of the rural and existing health system. The findings will be shared with all the stakeholders for policy implications. Clinical Trial: [NCT05640050]