Institutionalization of Quality Improvement and Humanization of Maternal and Neonatal Care in Mozambiques National Model Maternities Initiative

Background: Model Maternities Initiative

The MMI is part of the National Plan for the Humanization and Quality of Health Care, launched in July 2009, during the VI National Hospital Council

MMI General Objective:

Transform the selected Maternities to centers

of quality and humanized care provision and teaching centers in Maternal and Neonatal Health.
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Model Maternities Initiative: Concept and Rationale The Ini(a(ve is built on the principles of Humaniza(on and Quality Maternal and Neonatal Health Care through an approach that:

q Centers on the individual; q Emphasizes the fundamental rights of the

mother, newborn and families;

q Promotes birthing prac(ces that recognize

womens preferences and needs;

q Focuses on humanis(c care and the

scaling-up of high-impact interven(ons.

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Promo(ng humanized birthing prac(ces, which recognize womens rights, preferences and needs

Health Facilities Included in the MMI Process

Health Facili(es # of current Health Facili(es Included in the MMI Process 3 7 5 33 32 80

Total # of Health Facili(es of this type in Country

(HIS, Dec 2011)

Central Hospitals Provincial Hospitals General Hospitals Rural and District Hospitals Health Centers Type I and A TOTAL

3 7
(5 with Maternity)

(33 with Maternity)

39

(130 with 6 or more Maternity beds)

193 249
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Standards Based Management and Recognition

SBM-R 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

AREAS DESCRIPTION

N of QUALITY STANDARDS

1. 2. 3. 4. 5. 6. 7. 8. 9.

Humanized Management of Maternal & Neonatal Services Informa(on, Monitoring and Evalua(on Resources: Human, Infrastructures and Commodi(es Humaniza(on of work condi(ons and safety Health educa(on and Community involvement Humaniza(on of Pre-Natal and Post-Natal Care for Women and Newborns Humaniza(on of Care during normal labour, delivery and immediate post-partum Management of Obstetric and Newborn Complica(ons Teaching Process
TOTAL

8 5 4 9 4 14 24 10 4
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Process Followed by each Model Maternity

Carry out standards baseline measurement and conduct gap analysis

Clinical Training of Health Care Providers

First Action Plan Implementation

Revision of progress and continued implementation of action plan according to needs identified in quarterly internal assessments

External evaluation and recognition

Elaborate Action Plan to address identified needs

Subsequent quarterly measurements of quality standards; update of action plans; monthly monitoring of selected indicators; internal recognition process

Health Professionals Trained

Since the beginning of MMI process (August 2009), 795 Health Professionals have been trained:

q155 Trainers and

Preceptors

q640 Service Providers

(Doctors, MCH Nurses and Surgical Technicians)

Model Maternity Initiative Monitoring and Evaluation System

q Quarterly Measurement of Quality Standards q Monthly analysis and report of selected indicators
Use of Active Management of Third Stage of Labor Use of Mg sulfate for severe pre-eclampsia / eclampsia Partograph completely filled out Presence of a labor companion Presence of birth companion Birth in vertical/semi-vertical position Skin to skin contact, mother to newborn Immediate breastfeeding
Health Information System
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Since January 2012: MMI Indicators are included in the National

Institutionalization of Quality Improvement and Humanization of Care The institutionalization process includes the creation of Quality and Humanization committees at the national, provincial, district, facility, and community levels

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Selected Results of the MMI SBM-R Process

Quality Standards: Comparison between Baseline and Last Measurement
Data from 28 Health Facili(es

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Quality Standards: Comparison Between Baseline and Last Measurement

Data from 28 Health Facili(es

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Comparison Between Quality Standards Achieved in the Area of Humanized Care

Beira Central Hospital, 2011

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Successful Approaches
q Working together with pre-service training institutes and inservice trainers creates a more sustainable training process;

q Creating a pool of trainers that also act as supervisors; q Letting provinces organize most aspects of the cascade
training helps them to grow;

q Identifying champions at central and provincial level is crucial

for the smooth implementation of interventions;

q Being attentive and clarifying critical managerial and technical

issues along the way (eg, how to better organize labor and delivery rooms; how to store/conserve oxytocin; how to ensure systematic use of partogram; how to introduce new practices like birth in the vertical position, skin to skin contact, AMTSL, etc.)
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Jos Macamo General Hospital Maternity

Model Maternity with the highest monthly average of deliveries = 1070

Before

Aier

OBRIGADO