Table 5.

Summary of main gaps emerging from the baseline assessments: policies (compared with WHO standards 1, 2, 3, 5 and 7) [7]

WHO quality standards	Areas where serious gaps were identified in at least 1/3 of the health facilities	Examples of gaps
Standard 1: Every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the early postnatal period, according to WHO guidelines.	National clinical guidelines and local protocols	Lack or poor access to clinical guidelines for case management.
		Lack of local protocols.
		Lack of essential drug list.
	Infection prevention and control	Inappropriate hand washing by staff.
		Sterile gloves used inappropriately as a substitute for hand washing.
		Mosquito nets available but patients not encouraged to use them.
		Inadequate registration of nosocomial infections.
		Lack of guidelines for appropriate use of antibiotics both in obstetrics and neonatology.
Standard 2: The health information system enables use of data to ensure early, appropriate action to improve the care of every woman and newborn	Data collection and use	Poor information system.
		Poor local use of data for care provision and organization.
		Substandard or poorly filled medical records.
	Periodical perinatal audit	Lack of medical record for newborn babies.
		Absence of maternal and perinatal case reviews.
		Insufficient capacity to use maternal and perinatal audits for identifying and addressing gaps in organization, skills or procedures.
Standard 3: Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred	Perinatal referral system	No criteria-based functional referral system for mother and newborns.
		Insufficient communication among different levels of care.
Standard 5: Women and newborns receive care with respect and preservation of their dignity	Access to care	Official and unofficial fees requested.
		Need to pay for drugs and consumables (cannulas, catheters, syringes, gloves, etc).
Standard 7: For every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications.	Human resources development and/or deployment	Insufficient number of midwives
		Lack of continuous professional development, especially for paramedics.
		Insufficient involvement of midwives into care provision and organization.