Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

Objective: To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015.

Design: Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015.

Setting: Eleven large government hospitals from five regions in the Philippines.

Participants: One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery.

Interventions: A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication.

Main Outcome Measures: Sixteen intrapartum and newborn care practices.

Results: Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted.

Conclusions: Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.