Quality of Care in Côte d'Ivoire

With high level national commitment to improving the quality of care, Cote d’Ivoire joined the Quality of Care Network in 2017. Maternal and newborn health were identified as a priority and a National Quality and Operational Plan for maternal and newborn health was developed in 2017 to address emergencies and reduce maternal and child mortality by 2020. A National Quality Policy and Strategy was developed in 2018, which has led to the expansion of the quality care agenda across the country.

Starting with two learning districts and eleven facilities, Cote d’Ivoire has scaled up the implementation of Maternal and newborn quality of care (MNH QoC) to three districts and eighteen facilities by 2022. Each health facility has set up its own MNH QoC focal person who reports regularly  to the head of the epidemiological service of the learning district for data collection. To operationalize quality care for MNH, the "5-star health structure" label was developed in 2020 to assess quality of care in health facilities. In order to receive the "5-star health structure" label, healthcare workers and health structures are assessed on both Maternal, Newborn and Child Health (MNCH) and WASH. This approach is currently being institutionalized in three facilities and will be scaled up to fifteen facilities in 2022.

Healthcare workers appropriated the QoC initiative and are continuously capacitated on QoC assessment tools and processes. A clinical midwifery mentoring initiative was initiated in early 2022 in which regional mentors were selected and trained on key quality of care interventions. In addition, a self-assessment tool was developed to assess the performance and quality of maternal and newborn care.

Facility-based data on selected number of MNH indicators are collected and reported on DHIS2. In order to address data collection bottlenecks and ensure data is being collected regularly, the national focal person for monitoring and evaluation is in permanent contact with the data collection officers in the learning districts and data collection field missions are planned to take place 2022.

Partners are mobilized and well aligned around the Quality of Care Roadmap in 2022. Partners supporting the Ministry of Health in the learning districts include WHO, UNFPA, UNICEF and JICA. New partnerships with IPAS, Momentum (Jhpiego & USAID), Pathfinder International, the Global Fund and GFF were signaled in 2021 to support the implementation of the MNCH Action Plan for 2022. There has been increased attention by implementation partners on MNH QoC which lead to the revitalization of the Technical Working Group (TWG). In 2021, a decree stating the attributions, organization and operation of the maternal and newborn health TWG bodies was issued. In 2022, TAKEDA officially launched a new implementation project in Cote d’Ivoire focusing on ensuring access to life-saving maternal health services for mothers within two hours. With the support of the Momentum Country and Global Leadership Project (MCGL), six cheat sheets on intra-partum care were developed in 2021.

Reportedly, the quality of maternal and newborn health services is improving over the years with better management of blood products and implementation of quality care protocols. Moving forward, respectful maternity care is being prioritized at national level. Over the past 2 years, the COVID-19 pandemic and the structural changes within the Ministry of Health have delayed the implementation of MNCH QoC activities. There are also challenges in sustaining gains and scaling up of the initiative to other districts and health facilities. Moving forward, better coordination of quality of care activities between national actors is needed to ensure the scalability of the intervention. Cote d’Ivoire is planning to develop an action plan to effectively engage the private sector in the delivery of quality MNCH services in the country. Efforts to increase community engagement and participation is also to be taken into account in 2022.

Photo: Newborn baby in the health center of Port Bouet, a suburban area of Abidjan, the capital of Côte d'Ivoire,in September 2018. ©UNICEF/Dejongh