Quality, Humanized & Respectful Care for Mothers and Newborns The Model Maternity Initiative Field Office: Mozambique Presenter: Maria da Luz Vaz
Presentation Outline Country: Main Demographic and Health Indicators; Model Maternity Initiative: Background, Concept and Approach to Improve Quality, Humanized and Respectful Care; Key Results: Service Delivery, Humanization & Respectful Indicators; Main Challenges & the Way Forward to Improve Quality and Humanized/Respectful Care. 2
MOZAMBIQUE Total Population: 24,366,112 (70% lives in Rural Areas) Pop. Living Below Poverty Line: 54.7% GFR (DHS, 2011): 5,9 (Rural 6,6; Urban 4,5) Access to HC Services: 25% in 1992 to 54,3% in 2011 Skilled Birth Attendance (DHS, 2011): 54,3% Ratio Inhabitants per Doctor: 24,333 Ratio WRH + Children<5 per MCH Nurse: 2,365 CPR: 11,3% (DHS, 2011) HIV Prevalence: 15-49 years: 11.5%; Pregnant Women: 10.4% MMR: 1000/100.000 LB in 1990; 408/100.000 LB in 2003 and 2011 NMR: 59/1000 LB in 1990; 48/1000 LB in 2003 and 30/1000 LB in 2011 3
Model Maternity Initiative (MMI) MMI General Objective: Transform the selected Maternities to centers of quality and humanized/respectful care provision and teaching in Maternal and Neonatal Health. This Initiative is implemented through 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; Focuses on humanistic/respectful care and the scalingup of evidence-based high-impact interventions. 4
Promotion of humanized birthing practices, which recognize women s rights, preferences and needs: 5
Scaling-up of high-impact interventions: 6
Health Facilities included in the MMI Process Health Facilities # of current Health Facilities Included in the MMI Process (Note 1) Total # of Health Facilities of this type in Country (HIS, Dec 2011) Central Hospitals 3 3 Provincial Hospitals 7 7 General Hospitals 5 Rural and District Hospitals 33 Health Centers Type I and A 47 7 (5 with Maternity) 39 (33 with Maternity) 193 (130 with 6 or more Maternity beds) TOTAL (Note 2) 95 249 Note 1. Current MMI facilities account for around 35% of all institutional deliveries; Note 2. At the end of 2014 will be a total of 125 Maternities in the MMI Process, that will attend around 50% of all institutional deliveries 7
MMI Quality Process Is based on the SBM-R approach, focusing on the implementation, monitoring, evaluation and recognition of quality standards in 9 areas 8
AREAS DESCRIPTION Nº of QUALITY STANDARDS 1. Management of Maternal & Neonatal Services 8 2. Information, Monitoring and Evaluation 5 3. Resources: Human, Infrastructures and Commodities 4 4. Humanization of work conditions and safety 8 5. Health education and Community involvement 4 6. Humanization of Pre-Natal and Post-Natal Care 14 7. Humanization of Care during normal labour, delivery and immediate post-partum period 8. Management of Obstetric and Newborn Complications 10 9. Teaching Process 4 TOTAL 81 24 9
MMI Monitoring & Evaluation Monthly analysis and report of selected indicators Quarterly Measurement of Quality Standards Since January 2012: MMI Indicators are included in the National Health Information System 10
Main Results 11
Model Maternity Initiative - Evolution of Selected Humanization Indicators: Mother and Newborn
Selected Humanization Practices: Urban Versus Rural Areas 13
Area 7: Humanization of Care during Normal Labour, Delivery and Immediate Post-Partum Respectful Care Behaviors Demonstrated by the Health Care Provider Data from 10 randomly selected Maternities 14
Model Maternity Initiative - Evolution of Selected Maternal Health Interventions Indicators 15
The MMI has had an impact on the attention provided to the Mother and Newborn at Country Level Selected Maternal & Newborn Health Care Indicators: All Maternities (MMI and Non MMI) HIS 2012 INDICATOR VALUE % Of Births with Companion during Delivery 59% % Of Deliveries in Vertical and Semi-Vertical Positions 40% % Of Deliveries with AMTSL 91% % Of Pre-Eclampsia & Eclampsia treated with MgSO4 67% % Of Deliveries with Partograph Completed 70% % Of Babies with Direct Skin-to-skin Contact with the Mother Immediately After Birth 85% % Of Babies Breastfeed within the First Hour after Birth 86% 16
Improving Quality & Respectful Care Is a journey where we should walk together in order to find sustainable ways to overcome every challenge! 17
Human Resources Reinforcement Challenge Shortage and retention of trained staff at health facilities Way Forward Ensuring that all staff in a Maternity is trained on- job through the Modular In-Service Training Packages. Piloting a mmentoring approach to improve/retain knowledge and change personnel attitudes. Working with EGPAF to pilot a Performance Based Incentives Scheme for Model Maternities Facilities. Low Motivation Improve work conditions: reengineering and improving physical spaces and providing materials for health personnel benefit (ex. electric tea kettle). Institutionalizing a grade recognition system based on the Quality Standards and Selected Indicators Achievement for HF and Professionals 18
Health Systems Strengthening Challenge Weak Health Information System and M&E Poor logistics management system (with shortage and stock out of several commodities and consumables) Way Forward Providing technical support to revise MCH registers, as well as providing on-site TA at Facility-District-Provincial levels to improve data collection, analysis and reporting quality. Technical assistance on SRH commodities forecasting and distribution (such as Syphilis tests, Oxytocin, Magnesium Sulfate, Family Planning Methods). Providing a kit of material, equipment and consumables for Model Maternities. Technical support and advocacy with USAID to define a list and purchase essential materials and equipments 19
Health Systems Strengthening Challenge Way Forward MCHIP is assisting the MOH: Providing close TA to National Q&H Committee; Inconsistent Use of Data to Improve Quality Establishing district and provincial Q&H committees to review data and to monitor improvement plans; Give technical and financial assistance to establish facility-community co-management committees to motivate improvement; Improve the Central MoH M&E Unit and to establish a National Quality Standards Database. 20
Health Systems Strengthening Challenge Inadequate and poor maintenance of infrastructure (Significant infrastructure improvements are needed at health facilities to bring them to Model Maternity status) Minimal participation of communities in demand for services Way Forward MCHIP is supporting the MoH: Re-engineering of space and doing small scale infrastructure improvements in selected Model Maternities. Undertaking advocacy efforts with USAID for additional funds. MCHIP has added a community component to selected Model Maternities, to improve community-facility linkages, demand for services, and community participation in the health care evaluation. 21
José Macamo General Hospital Maternity With the higher monthly average of deliveries = 1070 Before After
Thank You Very Much! 23