Improving Quality and Access to Improving Quality and Access to Essential Obstetric Care: Essential Obstetric Care: The Latin American The Latin American Maternal Mortality Reduction Maternal Mortality Reduction Initiative (LAMM) Initiative (LAMM) Stephane Legros, MD, MPH, MBA QAP/URC-CHS SOTA meeting Miami, FL March 15, 2001
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Improving Quality and Access to Essential Obstetric Care: The Latin American Maternal Mortality Reduction Initiative (LAMM) Stephane Legros, MD, MPH, MBA.
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Improving Quality and Access to Improving Quality and Access to Essential Obstetric Care:Essential Obstetric Care:The Latin American The Latin American Maternal Mortality Reduction Maternal Mortality Reduction Initiative (LAMM)Initiative (LAMM)
3 countries: Bolivia, Ecuador, and Honduras Activities began mid-98 Project area: average of 200,000 inhabitants
per country Community and facility interventions Three levels of care: primary, district, and
regional MMRs range from 390 to 108/100,000
Components of LAMM initiative
2. Process (Re)designProcess
3. ImprovementProblem solving
4. Providerperformanceimprovement
5. EOC Standards communication
guidelines, job aids
6. Monitoring systemEOC indicators,
rapid surveysClinical audit,
Maternal death audit
Leadership in EOCLocal steering
committees, community governance
7. Linkages informal/formal
providers
1. Community
mobilization
Presentation Road Map Presentation Road Map QA interventions within LAMMQA interventions within LAMM
Recognitionof problem
and Decisionto
seek care
AchievingAccess to
Care
ReceivingQuality Care
Essential Obstetric Care system
I.E.CCommunityMobilizationTraining
Transportation
Referral/Counter-referral
Reception/Triage
Prenatal CareManagement of labor and deliveries
Management of ComplicationsPost-partum care
Commodities and SuppliesSupervision
TrainingMonitoring of system performance
Medical Records
Pathway to Maternal Survival
From the Community to the Facility: From the Community to the Facility: Access and Quality of CareAccess and Quality of Care
Processes
from Mother Care project, M.Koblinski
1. Community Mobilization1. Community MobilizationKey ComponentsKey Components
Training programsIEC Referral systemMonitoring systemEmergency access plansCommunity revolving funds
Impact of Community Impact of Community Mobilization in EcuadorMobilization in Ecuador
Training ModulesTraining Modules
Human body
Pregnancy
Delivery
Neonate
In preparation
Post partum
IECIEC
Posters
Flyers
Radio spots
Soap operas
IECIEC
Plastic disc to estimate date of delivery
Referral SystemReferral System
Specific form used for:
• Prenatal care
• Delivery
• Postpartum
• Neonate and FP
Monitoring SystemMonitoring System
Specific form developed for mother and neonate
• Complications
• Location of delivery
• Health outcomes
Emergency Access PlanEmergency Access Plan
• Developed by community
• Negotiated with drivers
• Displayed in grocery store
Results at Community Level Results at Community Level in Ecuadorin Ecuador
Percent of Communities with Emergency Access Percent of Communities with Emergency Access Plans and Community Revolving Funds for Plans and Community Revolving Funds for