Can stronger clinical audit and oversight improve the quality of partograph documentation in maternity care?
This study assessed whether the involvement of health insurance medical advisors under the Democratic Republic of the Congoโs free maternity care policy was associated with improved partograph documentation in maternity units of the Lemba Health Zone.
Using a clinical audit approach, the researchers compared partograph documentation before and after introduction of the free maternity care policy and its accompanying medical-advisor audit mechanism.
A total of 844 partographs from 12 maternity units were evaluated across two comparable periods using a checklist adapted from the ANAES framework.
The analysis found that overall documentation compliance improved after the policy and audit mechanism were introduced.
The number of assessed criteria achieving a compliance rate of at least 75% increased from 23 to 31 out of 34 criteria.
Some of the largest improvements were observed in documentation of laboratory examinations, which increased from 36.0% to 82.0%, and integration of the partograph into the medical record, which rose from 36.0% to 77.7%.
Documentation of amniotic fluid characteristics also improved substantially, increasing from 66.0% to 96.2%.
Immediate postpartum monitoring showed another major improvement, rising from 39.0% to 86.0%.
Despite the overall progress, some obstetric parameters remained below the target compliance threshold.
Documentation of fetal position reached 57.6%, while documentation of the level of the presenting part reached 58.1%.
The findings suggest that medical-advisor involvement and structured audit mechanisms can contribute to better obstetric documentation within a free maternity care system.
However, the study also shows that administrative oversight alone may not be sufficient for more technically demanding clinical parameters.
The authors therefore emphasise the need to strengthen healthcare providersโ competencies in clinical monitoring and obstetric documentation alongside audit and quality-control mechanisms.
๐ Read the full article here:
https://doi.org/10.46481/asr.2026.5.3.504
Published in: African Scientific Reports