A tool for assessment of health service systems to support maternal health and child health Health during early childhood and pregnancy has long term and wide ranging impacts on the general health of populations. Promotion of good health in pregnancy and childhood are therefore critical activities of primary health care services. Health service systems need to be organised to meet the specific needs of maternal and child care alongside the other major aspects of these services, such as acute and chronic illness care.
Health care organisations require practical tools to guide efforts and evaluate changes in maternal and child health. This ABCD Systems Assessment Tool was originally designed for assessing primary care systems support for chronic illness care. The tool is based on the structure, content and principles of the Assessment of Chronic Illness Care (ACIC) survey (Bonomi et al. , 2002) and on the Innovative Care for Chronic Conditions (ICCC) Framework (WHO 2002).
We have now adapted the Systems Assessment Tool for use in quality improvement activities directed at maternal and child health (MCH). This adaptation is based on key policy reports and research papers relevant to the Australian Aboriginal and Torres Strait Islander primary care sector (see list on last page). As for the ABCD Systems Assessment Tool for chronic illness care, this MCH Systems Assessment Tool has been designed for use with health services for Indigenous Australian populations.
However, it is expected to be appropriate with minor adaptation for many other settings. The intended purpose of the tool is to support ongoing quality improvement initiatives through systematic assessment of a range of elements of health service systems that have been demonstrated to be important. The tool provides for • an assessment of the state of development of health service systems; • guidance on next steps in planning improvements in maternal and child health care;
• assessment of progress in achieving system improvement. As for the ABCD Systems Assessment Tool, this MCH Systems Assessment Tool incorporates the guiding principles of the ICCC Framework: evidencebased decision making; population focus; prevention focus; quality focus; integration; and flexibility/adaptability. Version 2. 1 Last Updated 30/03/07 Activities and programs relevant to maternal and child health care can be considered in three areas:
a) Clinical Services for maternal health through individual health promotion advice, clinical preventive care and the early detection of illness (includes antenatal and post natal clinics/screening, case finding, brief interventions/counselling – generally health centre based, one-to-one activities) b) Clinical services for child health through individual health promotion advice, clinical preventive care and the early detection of illness (including child health clinics, screening, growth monitoring, case finding, brief interventions/counselling – generally health centre based, one-to-one activities)
c) Community or Population based programs/activities, ancillary programs for maternal and child health (eg programs or activities designed to promote nutrition, breastfeeding, physical activity, oral/dental health, mental health, environmental health, and to reduce harm from cigarette smoke or alcohol) Each of these three areas of activities is important in the effective prevention and management of maternal and child ill health and the prevention of chronic illness in later years.
The quality of systems in place to support each of these three areas of activities or programs may differ quite markedly within the same health centre or health service. The scoring form for this tool provides for distinct scoring of how systems support each of the areas. The prompts provided in this tool are intended only as guidance to some of the sorts of system issues that one might consider for scoring each item of the tool.
These prompts are not intended to cover all relevant issues for all services. While there may be some overlap, the elements of the MCH Systems Assessment Tool can be applied separately to the assessment of systems to support a) services for maternal health; and b) services for child health. The use of this tool provides a score for the state of development of different aspects of health centre systems.
These scores may be used as a guide for where improvement efforts might be focussed. The scores should be seen as a guide only, and services should base their priorities on the range of information available and the opportunities for improvement in different areas. We will welcome suggestions or feedback from services which use this tool.