Get involved: www.qualityofcarenetwork.org

IVORY COASTIVORY COAST

References:1. Countdown to 2015, 2015 report See http://countdown2030.org/

2. Maternal Death Surveilance and Response Country Profiles (WHO 2016). See

http://www.who.int/maternal_child_adolescent/epidemiology/maternal-death-surveillance/country-profiles/

3. Causes of Maternal Death: Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB,Daniels JD, et al. Global causes of maternal

death: a WHO systematic analysis. Lancet Glob Health 2014;2: e323-e333.

4. Causes of Newborn Death: UNICEF 2016

https://data.unicef.org/resources/maternal-newborn-health-disparities-country-profiles/

5. Water, sanitation and hygiene in health care facilities, WHO and UNICEF (2016). See

http://apps.who.int/iris/bitstream/10665/154588/1/9789241508476_eng.pdf?ua=1

6. All other data received from the relevant Ministry of Health and UNICEF and WHO Country Offices.

PopulationFertility rate per womanTotal maternal deaths in 2015Neonatal Mortality RateStillbirth rate

Core demographic data

23 844 2284.95 30038 per 1,000 live births26.7 per 1,000 births

Demand for family planning satisfied 45Antenatal care (4 or more visits) 44Skilled attendance at delivery 59C-section rate 3Early initiation of breastfeeding 31Exclusive breastfeeding 12Postnatal visit for baby 34Postnatal care for mother 70

Coverage of key interventions

Costed National Implementation plan(s) for ma-ternal, newborn, child health availableMaternal and Newborn Lifesaving Commodities on the national Essential Medicine list:Reproductive Health (x of 3)Maternal Health (x of 3)Newborn Health (x of 4)Child Health (x of 3)Density of Docters, Nurses and Midwives (per 10,000 population)National Availability of Emergency Obstetric Care Services (% of recommended minimum)

Systems

Yes

-233

6.3

7

Snapshot of readiness to improve quality of care

Leadership Functional Leadership Structure for Quality Improvement Quality of Care Committees established in District Health Management TeamsPlans, strategies & standardsNational Quality of Care Strategy for the Health SectorNational Strategy for Maternal and Newborn Health addresses Quality of CareNational Quality of Care Standards and Protocols DataNational Situational Analysis for Quality of Care up to dateAssessment of Quality of Care in Health Facilities completed in the past two yearsSupporting systems Maternal and Perinatal Death Surveillance and Response System established 13 Maternal and Newborn Lifesaving Commodities on the Essential Medicine listWater Coverage in Health Care Facilities (%)Skilled attendance at delivery (%)National Availability of EmOC (%)

Achieved In process Not started No data

55%59%15%

A Quality Improvement Coordination Committee is established. A Technical Coordination Work Group for Maternal and Newborn is represented on the Quality Improvement Coordination Committee.

Governance of quality of care improvement

Causes of death

National Causes of Newborn Mortality (2015)

Many partners are supporting quality improvement work including WHO, UNICEF, UNFPA, Muskoka, Man-agement Sciences for Health.

Partnerships for quality of care improvement

Global Causes of Maternal Mortality (2016)

Indirect causes27%

Abortion8%

Embolism3%

Haemorrhage27%

Hypertension14%

Sepsis11%

Other direct causes10%

Policies

Midwives authorised for specific tasks (x of seven)Maternal deaths notificationPostnatal home visits in first week after birthKangaroo mother care in facilities for low birth-weight/preterm newbornsAntenatal corticosteroids as part of the manage-ment of preterm labourInternational Code of Marketing of Breastmilk Substitutes

7 of 7YesYesYes

Yes

Yes

InfrastructuresTriage / flow of patientsWater, electricityOperating roomIntensive care unitLaboratoryReferralHuman resourcesNumber / typeNights and week endsTrainingCase managementHand washingPartogramProtocol AntibioticsEclampsiaProlapsed cordShoulder dystociaCaesarean sectionEquipment/drugsLaboratory proteinuriaHaemoglobin, haematocritUrine microscopyBlood grouping, count, glucoseBacteriology (culture)Drugsanti-hypertensiveanticonvulsantsmagnesium sulphate corticosteroidsdiureticoxytocintocolyticantibacterialIV cathetersBlood productsbloodEquipmentsphygmomanometersthermometersglovesUrine dipsticksoxygenincubatorCaesarean kit Anaesthesia kit Postpartum haemorrhage kitMedical information Medical recordFinanceFree health careSummaryMaternal case management

Treichville HospitalLabour

delivery Dystocia Postpartum

haemorrhageEclampsia Caesarean

sectionInfection Preterm

labour

Standards

Neonatal and Child Health Standards are currently being finalised.Available Standards and Protocols • National guidelines on minimum package of health

activities at district hospital level (2006)• National guidelines on minimum package of health

activities at first contact level facilities.• National compilation of treatment protocols

Only 35% of mothers in the poorest households had a skilled attendant at birth, compared to 91% of mothers in the richest households.

Disparity of the coverage of maternal and newborn care

35% 91%Poorest Richest

The National Health SectorDevelopment Plan (2016-2020)emphasises the delivery ofquality service.

In June 2016, the NationalPolicy on Quality Improvementfor Health Services in CoteD’Ivoire was launched.

National quality of care strategies and plans

Table 1: Evaluation of labour and delivery management, based on clinical conditions at Treichville Hospital (2015)

Health Facility Assessment

In 2015, an assessment of the quality of care and service for maternal, newborn and child health was undertaken in five hospitals. See Table 1 for the results for Treichville Hospital, the largest Teaching Hospital in the country.

%

conforminggood

non applicablenon-conforming

considerableimprovements

to be improvedsome improvements

Congenital abnormalities6%

Tetanus, 1%

Pneumonia, 6%

Diarrhoea, 1%

Other conditions, 6%

Sepsis/meningitis20%

Preterm birthcomplications32%

Intrapartum-related events27%