Stork Network in Pernambuco, Brazil: an overview of SUS auditing in the evaluation of prenatal care.

The Stork Network (SN) strategy was created to guarantee comprehensive care and address high maternal and infant mortality rates. The aim of this study was to assess the actions developed by the SN across municipalities in the state Pernambuco and the association between these actions and prenatal care quality indicators. We conducted a multi-group ecological study of Component I of the SN in Pernambuco using data from audits conducted under the state component of the National Audit System for the period 2017 to 2020. We explored the association between ten actions and the prenatal care quality indicators. The indicators with the highest ratings were "improved access to high-risk prenatal care", "rapid syphilis/HIV testing" and "laboratory testing for low and high risk pregnant women". The indicator with the strongest association to mean congenital syphilis rate was rapid testing for syphilis/HIV. Two indicators showed a statistically significant association with mean perinatal mortality rate: "improved access to high-risk prenatal care" and "support for travel". We conclude that the organizational management of the SN in Pernambuco and provision of services under component I did not meet the objectives of strategy. Our findings demonstrate the potential of auditing for supporting policy implementation.