Feasibility and relevance of ‘Beyond the numbers' methods in Uzbekistan

Uzbekistan is a former republic of the Soviet Union, which gained independence in 1991. Quality assurance interventions are needed to make progress in reducing maternal mortality and severe morbidity. The collection of five methods, called ‘Beyond the Numbers (BTN)’, by WHO {WHO, 2004, 4536} is considered for implementation. The data were collected during a field visit in June-July 2007, prior to the introduction of BTN. Methods of data collection were: participant observations (N=12), structured self-filled questionnaires (N=27); in-depth interviews with key informants (N=25); participant observations in maternities; semi-structured interviews with patients (N=7). Results: Participation of midwifes and other non-medical staff in discussions is highly problematic. Important issues coming up include that the patient and the relatives need to be interviewed, but it is not clear by whom. Informal payments and relations are traditional hindering open discussion. It will be problematic to ensure confidentiality and not-hierarchical facilitation, especially in smaller facilities, where “everybody but the boss knows everything anyway”. Whether facility based near-miss case reviews will have policy effects on a higher level is not clear. Currently there is an enormous enthusiasm, related to possible moratorium on punishments. Conclusions: Selection of uncomplicated cases so there will be no one to really blame, limiting the discussion group to the staff not bounded by administrative power links, developing history of reviews which were not followed by punishments are all seen as important by the respondents. BTN will increase the need for evidence-based information.