HARAMAAYAA YUUNIVERSITII

HARAMAYA UNIVERSITY

COLLEGE OF HEALTH AND MEDICAL SCIENCE DEPARTMENT OF MIDWIFERY

[Clinical Midwifery Specialist (CMS)]

COURSE: CLINICAL AUDIT

TASK: CLINICAL AUDIT PROJECT PROPOSA

TITLE OF MY PROJECT:

CRITERIA BASED CLINICAL AUDIT TO IMPROVE WOMEN FRIENDLY CARE IN MATERNTY

WARAD IN JUGAL HOSPITAL, HARARI, ETHIOPIA 2022.

By: MERWAN KEMAL (BSc , MSc fellow @ HU )

Id number: sgs/1102/14

Submission date: 13/1/2015 E.C

Submitted to: Abera Kenay ( PhD

 1 Stake Holders
This study will include all necessary participant including Nurses, Midwives, Clients, coordinators, hospital quality
office ,director and others.

2 Acknowledgements
First, I would like to thanks my Allah. Then my deepest thanks to Dr. Abera Kenney for his teaching clinical
audit course and guiding us to do clinical audit project proposal. Finally would like thanks all jugal Hospital
staff, for guiding me and providing me all necessary information for this proposal.
4 Acronyms and Abbreviations

ANC Antenatal care

RMC Respect mother child

HCP health care providers

SBA Skilled birth attendants

MCHIP Maternal and Child Health Integrated Program

MMR Maternal mortality rate

SDG Sustainable Development Goal

SVD Sapoustance vaginal delivery

C/S Caesarian section

Contents
1 Stake Holders............................................................................................................................................................................. 2
2 Acknowledgements.................................................................................................................................................................... 2
4 Acronyms and Abbreviations..............................................................................................................................................3
INTRODUCTION......................................................................................................................................................................4
4 Aims and Objectives...............................................................................................................................................................5
4 Objectives...............................................................................................................................................................................6
5 Standard Criteria.................................................................................................................................................................... 6
6 Methodology..........................................................................................................................................................................6
7 Study setting and period........................................................................................................................................................7
8 Study Design...........................................................................................................................................................................7
Study population....................................................................................................................................................................... 7
Sample size................................................................................................................................................................................ 7
Sampling Procedure.................................................................................................................................................................. 7
Statistical Instruments/ study analysis......................................................................................................................................7
Ethical approval......................................................................................................................................................................... 7
Annexes 1: referen....................................................................................................................................................................8
Table 1: Work plan....................................................................................................................................................................8
Annexes 2: Questionaries’.........................................................................................................................................................9

INTRODUCTION
Although there is a momentous reduction, maternal mortality ratio (MMR) is still 239 and 12 per 100,000 live births
in developing and developed countries respectively [1]. Regardless of an enlightened improvement in maternal and
child health services in Ethiopia; nearly three-fourths of mothers do not deliver in health facilities and do not attend
by skilled birth attendants (SBA). Moreover, the MMR is still 412/100,000 live births [2]. This figure is very far
from the target under the Sustainable Development Goal (SDG) by 2030, which is < 70/100,000 [3]. Absence of
companion during labor, substandard maternity service, long waiting time to receive care, and disrespect and abuse
during childbirth are some of the factors that contribute to the underutilization of facility delivery [4,5,6,7

Respectful maternity care (RMC) during childbirth is

an interaction between the client and the healthcare pro-
viders (HCPs) or facility conditions. It has a significant
role in MMR reduction by enhancing clients’ inclination
to deliver in health facilities [8–13].
Respectful maternity care (RMC) during childbirth is
an interaction between the client and the healthcare pro-
viders (HCPs) or facility conditions. It has a significant
role in MMR reduction by enhancing clients’ inclination
to deliver in health facilities [8–13].
Respectful maternity care (RMC) during childbirth is
an interaction between the client and the healthcare pro-
viders (HCPs) or facility conditions. It has a significant
role in MMR reduction by enhancing clients’ inclination
to deliver in health facilities [8–13].

Maternal mortality is high in countries where the proportion of births attended by skilled providers is low [1]. In
Ethiopia in 2010, the proportion of births attended by skilled providers was very low (10%). Poor quality of service,
lack of courtesy and respect from providers, fear of exposing the body to strangers, perceived cost of using a health
facility, and fear of being attended to by male providers during birth are all known to contribute to low institutional
delivery rates [2-5].

Respectful maternity care (RMC) during childbirth is an interaction between the client and the health care
providers (HCPs) or facility conditions. It has a significant role in MMR reduction by enhancing clients’
inclination to deliver in health facilities [8–13].

Women friendly care is an approach to care giving with the goal of an enabling environment at all level to
improve women’s access to safe motherhood and health services Reasons for low utilization of services at health
institutions include 1) cultural barriers, 2) provider-client interpersonal barriers, 3) economic barriers, and 4)
geographic barriers [3]. Similarly, a literature review conducted by the Maternal and Child Health Integrated
Program (MCHIP) in Ethiopia showed that women’s perceptions about health facilities’ cleanliness, equipment
quality or availability, provider competence, or behavior can be barriers to institutional delivery utilization.
Some communities express dissatisfaction with providers’ medical advice or management [4]

Women friendly care is an approach to care giving with the goal of creating an enabling environment at all level to
improve women’s access to safe motherhood and reproductive health services. It is paramount to improving service
utilization especially in settings where utilization is low [1].
 This approach focuses on the rights of women to have access and get quality care which has in turn has a
health benefit for their infants. Therefore, it is considered as part of a broader strategy in reducing maternal
and neonatal morbidity and mortality and requires strong partnerships between governments, health systems
and communities [2].

4 Aims and Objectives

This study aims to assess and improve women friendly care in maternity ward of Jugoll hospital, by
conducting criteria based clinical audit on women friendly care maternity forms, from august 8, 2022 to
September 8, 2022.

4 Objectives

1 To improve the women-friendly care services in maternity unit

2 To enhance the women-friendly care as the national standard based on 14 criteria for maternal
services

3 TO Ensure of women-friendly service practices in maternity ward

5 Standard Criteria

Criteria (for women friendly care) selected to audit

1. Health worker greets all women when they arrive the health
2. Health worker introduces him/herself to women when they arrive the health facility
3. Health worker informs and allows all pregnant women to have a companion of their choice during lab
4. Health worker uses linens to cover women and ensure privacy during labour
5. Health worker uses curtains or screens to ensure privacy during labour and delivery
6. Health worker calls women or refer to them by their names and not by other names (e.g. bed number or
diagnosis)
7. Health worker keeps the maternity ward clean (i.e. beds, floors, windows, walls, lines)
 8. Health worker provides women with a clean bathroom and toilet
9. Health worker informs women of the different birthing positions (e.g. squatting, supine, kneeling)
10. Health worker allows women to adopt the birthing position of your choice
1. Health worker greets all women when they arrive the health facility
11. Health worker speaks the language that is easy for women to understand
12. Health worker respects all women and treat them with dignity
13. At least 80% of women are satisfied with the care they receive in the health facility
14. At least 95% of women will recommend the health facility to a friend or relative Table 2: Criteria (for women
friendly care) selected to audit

6 Methodology

Criterion-based audit cycle. Step 1, establish standards of best practice; Step 2, measure the current practice;
Step 3, compare the current practice with standards of best practice; Step 4, make and implement
recommendations to fill the gaps between current practice and best practice; Step 5, re-evaluate the
recommendations implemented and, where necessary, refine practice.

7 Study setting and period

A facility-based cross-sectional study was conducted is baseline study will take place from 8 august, 2022 to
8 September, 2022, at Harar town jogal hospitals, Eastern Ethiopia. The antenatal care (ANC), health facility
delivery and SBA coverage of the Region reach 75, 50.2, and 51.2% respectively [2

Study Design
This is a prospective interviews and observation designed to improve maternity women friendly care system by
auditing based on national standard referral form among randomly selected referred women in Harar from August
92022 to September 9, 2022 to the jogal hospital

Study population

All Women who visited the nominated Harar jogal hospitals for labor and delivery throughout the information assortment
period were included. Women who were fundamentally sick, and unfit to impart were excluded from the study jugal
hospital

Sample size

Sample size will be estimated based on available time and resource to collect data, so conveniently total
sample size of this study will be 50 women friendly care of to jogal hospital from all women to get
Sampling Procedure

I decided my sample size conveniently; I will collect May d

by using simple random sampling, which is lottery method to select adequate sample size from total
maternity service of to jogal hospital

Statistical Instruments/ study analysis

Data will be collected and entered to SSPS 24 version ; Descriptive statistics will be used such as frequency,
mean and percentages to present collected data representing the characteristics of maternal maternity service
of to jogal hospital
Quality of the systematic selected Criteria (for women friendly care) selected to audit friendly care will be
assessed based on the minimum elements

Ethical approval

Approval will be obtained from the authorities of the hospital, where the records will be reviewed. Ethics of
the audit will be protected, but for clinical audit no need to have ethical approval

Annexes 1: reference

1 Respectful maternity care and associated factors among women who delivered at Harar hospitals, eastern Ethiopia: a
crosss ectional study Agegnehu Bante1* , Kedir Teji2 , Berhanu Seyoum3 and Abera Mersha1
2 Respectful maternity care in Ethiopian public health facility Reena Sethi1* ,Shivam Gupta2 , Lolade Oseni3 , Angella
Mtimuni4 , Tambudzai Rashidi5 and Fannie Kachale6
3 Address: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, UK Email: Eugene J Kongnyuy* -
kongnyuy@gmail.com; Nynke van den Broek - vdbreok@liverpool.ac.uk * Corresponding author
4Research article Open Access Criteria for clinical audit of women friendly care and providers' perception in Malawi Eugene J
Kongnyuy* and Nynke van den Broek
Level of Women-friendly Care Provision Among Mothers in Immediate Post-delivery Period at Public Hospitals of Southeast
5Ethiopia: a Cross-sectional Study

6 prevalence of disrespect and abuse during facility-based maternity care in Malawi: evidence from direct observations of
labor and delivery Reena Sethi1* , Shivam Gupta2 , Lolade Oseni3 , Angella Mtimuni4 , Tambudzai Rashidi5 and Fannie Kacha
Table 1: Work plan

S/No Activity Responsible body Time period remark

1 Proposal MERWAN KEMAL August 9 , 2022 to august
development 15,2022
2 Data collection MERWAN KEMAL August 21s ,2022 to August 30,
2022
3 Data analysis MERWAN KEMAL September 3, 2022 to
September 10, 2022
4 Report writing MERWAN KEMAL September 11,2022 to
September 14, 2022
5 Result MERWAN KEMAL September 15,2022
presentation
6 Re Audit MERWAN KEMAL After three months of
intervention
7 Improvement MERWAN KEMAL Continuously any time

Annexes 2: Questionaries’
Socio demographic characteristics of referred women

1. Age

2. Marital status

a) Single c) Married
b) Divorced d) widowed

3) Residency a) urban b) ru

a) Client decision to be referred to

5) Pregnancy status of the women

a) Pregnant b) not pregnant

 6) Condition of the women during referral
a) Stable b) emergency c) critical

8) Place Referred from

a) Health Centre b) district hospital c) other health facility

9) If mother was delivered, place of delivery

a) Home b) health center c) Hospital

10) Mode of delivery a) SVD b) C/S

Criteria of Recommended standard national referral form Response

1) Health worker greets all women when they arrive the health 1) Yes
2) NO

2) Health worker introduces him/herself to women when they arrive the health facility 1) Yes
2) no
3) Health worker informs and allows all pregnant women to have a companion of their 1) Yes
choice during lab
2) no
4) Health worker uses linens to cover women and ensure privacy during labour 1) Yes
2) No
5) Health worker uses curtains or screens to ensure privacy during labour and 1) Yes
delivery
2) no
6) Health worker keeps the maternity ward clean (i.e. beds, floors, windows, walls, 1) Yes
lines)
2) no
7) Health worker provides women with a clean bathroom and toilet 1) Yes
2) no
8) Health worker informs women of the different birthing positions (e.g. squatting, 1) Yes
supine, kneeling)
2) NO
9) Health worker allows women to adopt the birthing position of your choice 1) Yes
2) No
10 Health worker greets all women when they arrive the health facility 1) Yes
2) NO

11 Health worker speaks the language that is easy for women to understand 1) Yes
2) No
12 Health worker respects all women and treat them with dignity 1) yes
2) NO

13 At least 80% of women are satisfied with the care they receive in the health facility 1) YES
2) NO
14 At least 95% of women will recommend the health facility to a friend or relative
Table