Humanization of Childbirth: A Worthwhile Investment for Health Care Services, Professionals, Clients and Communities Veronica Reis, MD, MPH – MCHIP Mozambique.

Humanization of Childbirth: A Worthwhile Investment for Health Care Services,

Professionals, Clients and Communities

Veronica Reis, MD, MPH – MCHIP MozambiqueLidia Chongo, MD – MoH Mozambique

18th International Congress on Women’s Health “CITIES AND WOMEN’S HEALTH: GLOBAL PERSPECTIVES” University of Pennsylvania, Philadelphia, USA, April 7- 10, 2010

Philadelphia, USA, April 9, 2010

OBJECTIVE OF THE SESSION

To share the results of efforts undertaken in Mozambique to promote the quality and humanization of healthcare, particularly in the area of childbirth.

Humanization of ChildbirthDEFINITION

“Humanization of childbirth” is an approach that: centers on the individual, emphasizes the fundamental

rights of the mother, newborn and families

promotes birthing practices that recognize women’s preferences and needs.

Considerations: evolution of the medical practices favors the “technocratic model”

The body as a machine

Separation between the body and the mind

Symbols of the “technocratic Model”

Centered on the professional

Disempowerment of the woman

Symbols of the “Technocratic Model” Use of no evidence based practicesUse of no evidence based practices

Symbols of the “Technocratic Model” Woman “solitary”

Separation between father - mother - newborn - family

Humanization of Childbirth includes:

Respecting beliefs traditions and culture

The right to information and privacy

Choice of a companion during childbirth

Liberty of movement during the labor

Humanization of Childbirth includes:

Choice of position for childbirth

Contact of the newborn Skin-to-skin with the mother

Use of evidence based practices

Guarantee of Emergency Obstetric and Neonatal Care, if necessary

Humanization of Childbirth

in Mozambique

MOZAMBIQUE CONTEXT

Population: 20 million

Among the 10 poorest countries in the world

Life expectancy at birth: 45 years

HIV prevalence: 16.2%

Maternal mortality: 408/100,000 live births

Neonatal mortality: 48/1,000 live births

Source: 2007 Census, DHS 2003

Photo: Ismael Miquidade

Main problems on the Health System identified by Mozambique MoH

Shortfalls in Infrastructure, lack of supplies and limited human resources in quantity and quality

Poor management of health services Long waiting times Lack of a welcoming reception Lack of privacy and limited information

provided to the client Minimal satisfaction of clients and health

workers.

Source: MoH Moz, 2007.

Investing in quality improvement and humanization of health care

In 2006, Mozambique Ministry of Health, with support from international partners, developed a National Plan to Improve the Quality and Humanization of Maternal and Child Health (MCH) Services that adopted a quality improvement methodology developed by Jhpiego: Standards-Based Management and Recognition (SBM-R)

Standards-Based Management and Recognition (SBM-R)

It is a practical approach that follows four main steps:

1. Setting performance standards based on national norms and international references

2. Implementing standards through a systematic methodology

3. Measuring progress to guide improvement toward standards

4. Recognizing achievement of the standards

2007-2008: Quality improvement process in 6 Provinces / 18 HC

Results:

By the end of 2008 Facilities doubled or tripled their performance, were operating at a higher quality level, adhering to established evidence-based standards.

Rural Hospital of Manjacaze An example of this movement!

At Manjacaze Hospital, located in the south of Mozambique in Gaza Province, staff has been working with the local community to guide the transformation of the hospital into a welcoming environment for clients. Humanization principles have been successfully incorporated into services.

These efforts have resulted in increased health worker and client satisfaction and increased demand for services.

At Manjacaze Hospital Humanization efforts included…

Trainning staff on the implementation of the MNH standards Disseminating information about humanization and quality of

care, and client rights; Ensuring the implementation of humanized childbirth and MNH

high impact intervention practices: Allowing women to be accompanied during labor and childbirth Freedom of movement during labor Allowing women to choose a position during childbirth Skin-to-skin contact of the newborn Active managment of the third stage of labor to prevent PPH

2009-2010 - Model Maternities Initiative A work in progress…

Considering the results achieved, the MOH expanded the quality and humanization improvement process in 2009 to the 34 largest hospitals throughout the country.

Trainig of Trainers – August 2009

2009-2010 - Model Maternities Initiative National and Regional training

20

2009 - Model Maternities Initiative Baselines and Action Plans

21

2009 - Model Maternities Initiative

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Promoting birth in vertical position, skin-to-skin care,

early breastfeeding...

Client satisfaction

One mother allowed to accompany her daughter during childbirth at a health center said: “This is what I can call true independence!”.

One young Mozambican woman that gave birth to her first child under humanized conditions, in a squatting position and accompanied by her partner, is now sharing her experiences with other women and communities in Mozambique, affirming, “We women must speak up to fight for our rights”. And the father of the baby said: “It was the most incredible experience of my life”.

Conclusion

Humanizing healthcare can improve quality of care, increase service utilization and client satisfaction

While more research is needed to measure the benefits of humanizing healthcare, current analysis of experiences in Mozambique demonstrate humanizing healthcare is a worthwhile investment

References

ACCESS. Module 4: Women-friendly Care. In: Best Practices in Maternal and Newborn Care: Learning Resource Package. Jhpiego-Johns Hopkins University. Baltimore-MD, USA. 2008.

Davis-Floyd R., St.Jonh G. From Doctor to Healer: The transformative Journey. New Brunswick NJ: Rutgers University Press. 1998.

Gupta and Nikodem. Maternal posture in labour. Eur J Obstet Gynecol Reprod Biol 2000 Oct;92(2): 273-277.

Jones R. O Homem de Vidro: Memórias de um obstetra humanista. Porto Alegre-BR: Idéias a Granel, 2004.

Maadi et al. Effects of female relative support in labor: A randomized controlled trial. Birth. 1999 Mar; 26(1): 4-8. Erratum in: Birth 1999 Jun; 26(2): 137.

MISAU. Atenção humanizada a mulher e ao recém-nascido durante o parto e o nascimento. Ministério da Saúde. Moçambique, 2007a.

MISAU. Plano Estratégico do Sector Saúde 2007-2012. Ministério da Saúde. Moçambique, 2007b.

MoH. National Integrated Plan To Achieve MDGs 4 & 5. Mozambique, 2009.

THANK YOU!