Improving Quality of Maternal and Newborn Care and Postpartum Family Planning Services in Madagascar Eliane Razafimandimby Chief of Party, MCSP
Background Mortality rate 18 16 14 12 1 8 6 4 2 Under-5, infant, and Neonatal Mortality in Madagascar 1992 1997 23 28 213 MDG 219 Roadmap Target Mortality rate 6 5 4 3 2 1 Maternal Mortality in Madagascar 1992 1997 23 28 213 MDG 219 Roadmap Target Under-5 mortality Neonatal mortality Infant mortality Source: Madagascar Demographic and Health Surveys and Millennium Development Goals (MDG) Survey While under-5 and infant mortality has decreased, neonatal and maternal mortality in Madagascar have remained stagnant.
RMNCH Quality Goals To strengthen the quality of maternal, newborn, and postpartum family planning (PPFP) care in primary health centers and hospitals in 16 regions for improved health outcomes for women and newborns
National level Sub-national level 16 regions (73%) 8 districts (65%) Facilities supported 753 primary level facilities (CSBs) 63 hospitals Population served: 17,391,85 MCSP Geographic Scope (increasing coverage in three phases)
A Systems Approach to Improving Quality National Level Global RMNCH policy and guidelines District /Regional level Building capacity of district teams Use of data for decision-making Shared learning and exchange Facility Level Targeted service-delivery support (competencybased training, supervision, commodities, and organization of services) Standardized MNH/PPFP data-dashboard QI / clinical governance teams and an engaging community Learning from challenges to improve quality of care Effective use of information High quality clinical services Quality Improvement Services centered on the needs of client and community Favorable work environment
Improving Measurement of Blood Pressure During ANC to Screen for Pre Eclampsia (N = 1,2,989 total ANC visits in 513 CSBs) % of women 1 9 8 7 6 5 4 3 2 1 - Aug Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun 215 216 217 218 Month Illustrative Improvements: Reorganizing ANC patient flow Routine measurement of blood pressure for every women Access and availability of essential commodities and medications in key areas Tracking measures on standardized dashboard
Improving uptake of postpartum FP before discharge (N = 28,24 total postpartum women discharged with a FP method of choice in 513 CSBs; does not include lactation amenorrhea method) 3 % of postpartum women 25 2 15 1 5 Illustrative Improvements: Reorganizing patient flow and care Provision of counselling in ANC and early labor Counselling results guiding provision of method after delivery Mar Jun Sep Dec Mar Jun Sep Dec Mar June 216 217 218 Month
Decreasing Institutional Maternal Mortality and Fresh Stillbirth Rate in 513 CSBs Maternal mortality ratio in CSBs (N = 183,483 total women delivered and 151 total maternal deaths in 513 CSBs) Fresh stillbirth rate in CSBs (N = 183,483 total newborns [live and stillborn] and 2,35 total fresh stillbirths in 513 CSBs) CSB MMR (per 1,) 3 25 2 15 1 5 Aug Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun 215 216 217 218 Month Fresh stillbirth rate (per 1,) 18 16 14 12 1 8 6 4 2 Aug Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun 215 216 217 218 Month
Decreasing hospital newborn mortality rate (N = 9,321 live births; 211 pre-discharge newborn deaths in five regional hospitals) Pre-discharge NMR 4 35 3 25 2 15 1 5 Dec Mar June Sept Dec Mar June Sep Dec 215 216 217 Month Illustrative Improvements: Mapping and redesigning patient care pathways Enhanced coordination across departments to expedite provision of care Strengthened compliance and adherence to national guidelines Introducing and maintaining resuscitation equipment where deliveries happen
Reflections and Recommendations Despite challenges (capacity / data availability), tracking quality measures helped drive improvement and motivate staff Ongoing support for standardized quality of care dashboards, health worker QI and data interpretation capacity is critical Leadership and commitment of national, regional and district managers and facility health workers is critical It s possible to achieve improvements at scale, even in a weak health system without quality structures
For more information, please visit www.mcsprogram.org This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-28. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. facebook.com/mcspglobal twitter.com/mcspglobal