Quality, Humanized & Respectful Care for Mothers and Newborns: The Model Maternity Initiative.

Quality, Humanized &

Respectful Care for

Mothers and Newborns:

The Model

Maternity Initiative

Presentation

Outline

Background, Concept and Approach to Improve Quality, Humanized and Respectful Care;

Key Results: Service Delivery, Humanization & Respectful Care Selected Indicators;

Lessons Learned;

Acknowledgements

Mozambique Team: Dr Lidia Chongo: Public Health

National Deputy Director – MoH;

Dr Sandra Leão: Director of the José Macamo Hospital Maternity;

Dr Ernestina Maia: Director of the Tete Provincial Hospital Maternity;

Dr Verónica Reis: MCHIP Senior Technical Advisor

Mr Matias dos Anjos: M&E Team Leader at MCHIP-MOZ

Dr Maria da Luz Vaz: MCHIP Technical Director

MOZAMBIQUE Population: 24+ million (70% in Rural Areas & 54,7% Living Below Poverty

Line)

TFR (DHS, 2011): 5,9 (Rural 6,6; Urban 4,5)

Access to HC Services: 25% in 1992 to 54% in 2011

Skilled Birth Attendance (DHS, 2011): 54,3%

Ratio Inhab/Doctor: 24,333

Ratio WRH&Children<5/MCH Nurse: 2,365

CPR: 11,3% (DHS, 2011)

HIV Prevalence: 15 – 49 years: 11.5% Pregnant Women: 10.4%

MMR: 1000 in 1990 to 408/100.000 LB in 2011

NMR: 59 in 1990 to 30/1000 LB in 2011 3

4

Model Maternity InitiativeGeneral Objective:

Transform the selected Maternities to centers of quality and humanized care provision and teaching in MNH.

MMI is implemented through an approach that:

4

Centers on the individual; Emphasizes the fundamental rights of the mother,

newborn and families; Promotes birthing practices that recognize women’s

preferences and needs; Focuses on humanistic/respectful care and the scaling-up

of evidence-based high-impact interventions.

Promotion of humanized birthing practices, which recognize women’s rights, preferences and

needs:

5

Scaling-up high-impact, evidenced-based interventions:

6

Type of Health Facilities# of current HF

Included in the MMI Process

Total # of HF of each type in Country

(HIS, Dec 2011)

Central Hospitals 3 3Provincial Hospitals 7 7

General Hospitals 5 7(5 with Maternity)

Rural and District Hospitals 33 39

(33 with Maternity)

Health Centers Type I and A 47

193 (130 – with 6 or more

Maternity beds)

TOTAL 95 249

Health Facilities included in the MMI Process

7

MMI Quality Improvement Process

Is based on the SBM-R approach, 4 main steps:

Nº of AREAS AREAS DESCRIPTION

Nº of QUALITY

STANDARDS

1. Management of Maternal & Neonatal Services 82. Information, Monitoring and Evaluation 53. Resources: Human, Infrastructures and Commodities 44. Humanization of work conditions and safety 85. Health education and Community involvement 46. Humanization of Pre-Natal and Post-Natal Care 14

7. Humanization of Care during normal labour, delivery and immediate post-partum period 24

8. Management of Obstetric and Newborn Complications 10

9. Teaching Process 4

TOTAL 81 9

MMI Quality Improvement Process SBM-R

Quality Improvement Process at Health Facilities

10

From 2010-June 2013: 1161 Health Professionals were trained:

155 Trainers:33 National Trainers90 Regional Trainers32 Tutors from training

Institutes

1070 Health Providers (Doctors, MCH Nurses and Surgical Technicians)

Main Results

12

MMI Standards Measurements in 60 Maternities

Trends of Selected Humaniza

tion Indicators

- MMI

Selected Humanization Practices:

Urban VERSUS Rural Areas

14

Area 7: Humanization of Care during Normal Labour, Delivery

and Immediate Post-PartumRespectful Care Demonstrated by the Health Care

Provider

Data from 10

randomly selected

Maternities

15

Model Maternity Initiative - Trends

of Selected Maternal Health

Indicators

16

17

All Maternities (MMI and Non MMI) – HIS 2012

MMI has had an impact on the attention provided to Mother and

Newborn at Country Level

17

86%0%% Of Babies Breastfeed within the 1st Hour after Birth

85%0%% Of Babies with Direct Skin-to-skin Contact with the Mother Immediately After Birth

70%0%% Of Deliveries with Partograph Completed

67%20%% Of Pre-Eclampsia & Eclampsia treated with MgSO4

91%0%% Of Deliveries with AMTSL

40%0%% Of Deliveries in Vertical and Semi-Vertical Positions

59%0%% Of Births with Companion during Delivery

20122009Maternal & Neonatal Selected Indicators

86%0%% Of Babies Breastfeed within the 1st Hour after Birth

85%0%% Of Babies with Direct Skin-to-skin Contact with the Mother Immediately After Birth

70%0%% Of Deliveries with Partograph Completed

67%20%% Of Pre-Eclampsia & Eclampsia treated with MgSO4

91%0%% Of Deliveries with AMTSL

40%0%% Of Deliveries in Vertical and Semi-Vertical Positions

59%0%% Of Births with Companion during Delivery

20122009Maternal & Neonatal Selected Indicators

Improving Quality & Improving Quality & Respectful CareRespectful Care

18

Is a journey with many challenges, however to find

sustainable ways to overcome them, all

partners should walk this journey

together!

Is a journey with many challenges, however to find

sustainable ways to overcome them, all

partners should walk this journey

together!

Work together with preservice training institutes and inservice trainers;

Identify champions at all management and services levels;

Maximize the utilization of “On-the-job training”;

Implement recognition systems and improvements in working conditions to increase health worker motivation;

Provide on-site M&E Technical Assistance at all levels;

Strengthen Logistics Management Systems;

Invest in re-engineering of spaces and in small-scale infrastructure improvements;

Establish HF-Community Co-Management Committees;

Lessons LearnedLessons Learned

José Macamo General Hospital

Maternity

Before

After

With the highest monthly

average of deliveries =

1100

20

Ghana

Male involvement at Birth – from the national DHIS

GHANA

10 regions Richard Boadu kindly supplied this dataAshanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern, Upper East, Upper West, Volta, WesternNumber of Facilities: ______

Period

Male involvement

delivery

Number of deliveries

overall

Percent of Deliveries w Male involv

Male involvement

at ANC MaleInvolve

FP

Male involvement

at PNCJanuary 2013 16,668 44,957 37% 17,307 4,932 6,913February 2013 16,300 43,300 38% 16,069 4,806 6,972March 2013 18,179 51,198 36% 16,594 4,895 7,551April 2013 20,112 54,421 37% 16,554 4,856 7,604May 2013 20,073 58,342 34% 16,719 5,488 7,598June 2013 18,599 52,796 35% 17,098 4,718 7,190July 2013 17,951 48,553 37% 17,217 4,938 7,619August 2013 16,655 44,728 37% 17,148 4,768 6,613September 2013 17,653 47,269 37% 16,547 4,823 6,813October 2013 18,940 51,734 37% 18,070 5,000 7,662November 2013 17,155 48,362 35% 17,050 4,726 7,618December 2013 16,914 43,292 39% 16,719 4,720 7,072

TOTAL 215,199 588,952 37% 203,092 58,670 87,225

Discussion:

What RMC indicators should be tracked routinely?

How would they be measured?