Making high-quality abortion care a priority—even in the world’s most remote regions

Thursday, November 6, 2014

health providers consulting

How does quality improvement become part of the routine, ongoing process of providing abortion-related care? At Ipas-supported training and service delivery sites around the world, that question is getting special attention—and the effort already is translating into better care for women in some of the world’s most remote and impoverished areas.

A recent example comes from Ethiopia, where Ipas has provided training to health officials on how to monitor and improve quality of care. A quality-improvement team visiting a hospital noticed that a young health officer was not using the latest recommended dosage regimen for second-trimester medical abortion. They gave him a copy of the most up-to-date, evidence-based clinical guidance, which he reviewed overnight. Two days later he reported that he had implemented the new regimen with a woman at the hospital and that it had worked well.  And most important, the woman had been able to leave the hospital and return to her family several hours earlier than she would have with the dosage regimen he had been using previously.

That site visit was part of an Ipas monitoring program that offers technical assistance on quality improvement to Ipas-supported facilities in Africa, Asia and Latin America. “It’s not about arriving with a checklist and finding fault,” says Ipas Senior Clinical Advisor Bill Powell. “We’re there to hear from providers and clinic staff about barriers, challenges and ideas for local solutions, provide up-to-date clinical guidance, and learn about promising practices and support providers.”  It’s a collaborative process, he says, aimed at improving care for women.

Ideally, each site visit includes observation of uterine evacuation services, with the permission of the client and provider. The visiting team—made up of Ipas Clinical Affairs and in-country Health Systems advisors—also looks at logbooks and goes over clinical questions with providers and facility managers. They discuss issues including:

  • pain management
  • offering a range of contraceptive methods
  • expanding choice for women by offering medical abortion
  • putting the latest clinical evidence into practice
  • making services more accessible and responsive to young women.

The program and trainings emphasize that improving quality is closely linked to creating a “safety culture.” Providers and facility managers are encouraged to view cases where complications arise—including serious adverse events—not as a time to point fingers and cast blame, but as a chance to learn and to improve future care. 

Powell recalls an incident in a remote area of Nepal, where an auxiliary nurse midwife at a health post provided a medical abortion for a woman in the community. The woman experienced severe complications. Bleeding heavily and in shock, she was admitted to a larger district hospital, where a doctor provided her with life-saving care. In that area of Nepal, Powell notes, there was a good chance the nurse would be accosted by angry family and community members, possibly leading to the discontinuation of abortion services at that health post. The doctor who had treated the complications, however, helped to diffuse the situation by making a point of meeting with the nurse, her administrator and community leaders. He reviewed the case with the nurse, and talked with the health post administrator and community leaders about the importance of the nurse’s work in providing safe abortion care.

“The doctor acknowledged that complications, though rare, do occur. His willingness to meet with the community and share that information helped to prevent abortion services from being cut off in that community,” says Powell. “That is a prime example of creating a safety culture.”

Dr. Deeb Shrestha Dangol, an ob-gyn and Senior Program Advisor for Ipas Nepal, notes that the doctor in that instance had received orientation on serious adverse events from Ipas Nepal at a provider network meeting. “The ‘no-blame’ approach is really important. We do orientations at the facility level and with stakeholders in the district, so that providers can feel supported and will continue providing services,” she says.

As Tibebu Aleymayehu, Ipas Senior Program Advisor, adds: “What these stories show is that partnership is the most important aspect of the monitoring program—whether it’s with communities, providers, or trainers—and that improving quality makes a real difference in women’s lives.”

Download the latest Clinical Updates in Reproductive Health.