Advancing maternal and newborn healthcare measurement: developing quality of care indices for postnatal and small and/or sick newborn care in low- and middle-income countries.

Background: High-quality healthcare for pregnant women and newborns, particularly postnatal care (PNC) and small and/or sick newborn care (SSNC), is essential to reducing maternal and newborn morbidity and mortality in low- and middle-income countries (LMICs). Poor quality of care (QoC) is a major contributor to preventable morbidity and mortality, emphasising the need for its improvement in health service delivery through systematic measurement and monitoring. Although indicators measuring QoC have been identified, there is a current gap in the availability of composite indicators that can summarise its complex, multidimensional nature. Here we present three systematically developed composite QoC indices for maternal PNC, newborn PNC, and SSNC, feasible to measure using existing data in LMICs. Methods: We developed a four-step process to define the indices. First, we identified interventions by reviewing global clinical guidelines and QoC frameworks. Second, we extracted discrete items recommended for delivery of each of the selected interventions from intervention-specific guidelines. Third, we mapped these items to health facility survey data to assess their alignment with standardised tools. Finally, we developed a quality readiness index (QRI) for each service area based on QoC frameworks, available data, and clinical guidelines. Results: The maternal PNC-QRI includes 12 interventions and contains 24 items, the newborn PNC-QRI includes three interventions and contains 16 items, and the SSNC-QRI includes eight interventions and contains 48 items. Data gaps across all three indices led us to exclude some evidence-based interventions and include a limited number of items. No data on provision/experience of care were available for maternal PNC, newborn PNC, or SSNC, so the indices reflect only facility readiness. Conclusions: The three QRIs provide composite measures for maternal and newborn PNC and SSNC readiness that could be adapted at the country level and operationalised using health facility assessment survey data, facilitating their use by decision-makers for planning and resource allocation. Revision of existing health facility assessments to address gaps in readiness and provision/experience of care measurement for PNC and SSNC would bolster efforts to monitor and improve care quality for mothers and newborns.