quality, humanized & respectful care for mothers and newborns: the model maternity initiative
TRANSCRIPT
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Quality, Humanized &
Respectful Care for
Mothers and Newborns:
The Model
Maternity Initiative
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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
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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
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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:
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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.
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Promotion of humanized birthing practices, which recognize women’s rights, preferences and
needs:
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Scaling-up high-impact, evidenced-based interventions:
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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
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MMI Quality Improvement Process
Is based on the SBM-R approach, 4 main steps:
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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
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Quality Improvement Process at Health Facilities
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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
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MMI Standards Measurements in 60 Maternities
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Trends of Selected Humaniza
tion Indicators
- MMI
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Selected Humanization Practices:
Urban VERSUS Rural Areas
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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
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Model Maternity Initiative - Trends
of Selected Maternal Health
Indicators
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All Maternities (MMI and Non MMI) – HIS 2012
MMI has had an impact on the attention provided to Mother and
Newborn at Country Level
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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
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Improving Quality & Improving Quality & Respectful CareRespectful Care
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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!
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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
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José Macamo General Hospital
Maternity
Before
After
With the highest monthly
average of deliveries =
1100
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Ghana
Male involvement at Birth – from the national DHIS
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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
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Discussion:
What RMC indicators should be tracked routinely?
How would they be measured?