In-service training to improve quality of health care

Argentine's neonatal mortality rate represents 60% of infant mortality; implementation of strategies that improve quality of neonatal care is a priority. Traditionally, the training of health professionals is accomplished through scientific meetings with little capacity for exchange; in-service training incorporates the identification and resolution of problems joining the daily patient care. Objective. To describe the in-service training program (ISTP), to identify its strengths as strategies for quality of care improvement and to evaluate its impact in four different Argentine maternity services. Method. Design: health services research intervention study, not controlled, before and after evaluation. Intervention. This program is a multidimensional strategy consisting in regular visits by a neonatologist and a nurse to health professionals in their own settings. Program stages: 1) service assessment and design of the action plan according to the priorities, 2) implementation, 3) consolidation and analysis through indicators. Results. Greatest impact was found over equipment and human resources improvement; we also observed an improvement in management related aspects like organization and coordination of care. The reduction of preventable deaths varied between centers. Conclusions. The in-service training program is an effective tool with measurable quantitative and qualitative results with positive impact on the quality of care. Conjunctural factors and political will were determinant on the program's success, as it is commonly seen in the implementation of strategies that involve changing established structures.