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Institutionalization of Quality

Improvement and

Humanization of Maternal and

Neonatal Care in

Mozambiques National ModelMaternities Initiative

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Background: Model Maternities Initiative

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The MMI is part of the National Planfor the Humanization and Quality of

Health Care, launched in July 2009,

during the VI National HospitalCouncil

MMI General Objective:

Transform the selected Maternities to centersof quality and humanized care provision andteaching centers in Maternal and Neonatal

Health.

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Model Maternities Initiative: Concept and Rationale

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TheIni(a(veisbuiltontheprinciplesofHumaniza(onandQualityMaternalandNeonatal

HealthCarethroughanapproachthat:

q Centersontheindividual;q Emphasizesthefundamentalrightsofthe

mother,newbornandfamilies;

q Promotesbirthingprac(cesthatrecognizewomenspreferencesandneeds;

q Focusesonhumanis(ccareandthescaling-upofhigh-impactinterven(ons.

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Promo(nghumanizedbirthingprac(ces,whichrecognizewomensrights,preferencesandneeds

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Health Facilities Included in the MMI Process

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HealthFacili(es#ofcurrentHealthFacili(esIncluded

intheMMIProcess

Total#ofHealth

Facili(esofthis

typeinCountryHIS,Dec2011)

CentralHospitals 3 3

ProvincialHospitals 7 7

GeneralHospitals 5 75withMaternity)

RuralandDistrictHospitals 33 39

33withMaternity)

HealthCentersTypeIandA 32193

130with6ormore

Maternitybeds)

TOTAL 80 249

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Standards Based Management and Recognition

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SBM-R is a practical approach that

follows four main steps:

1. Setting performance standardsbased on national norms and

international references

2. Implementing standards througha systematic methodology

3. Measuring progress to guideimprovement toward standards

4. Recognizing achievement of thestandards

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AREAS DESCRIPTION

Nof

QUALITY

STANDARDS

1. HumanizedManagementofMaternal&NeonatalServices 8

2. Informa(on,MonitoringandEvalua(on 5

3. Resources:Human,InfrastructuresandCommodi(es 4

4. Humaniza(onofworkcondi(onsandsafety 95. Healtheduca(onandCommunityinvolvement 4

6.Humaniza(onofPre-NatalandPost-NatalCarefor

WomenandNewborns14

7. Humaniza(onofCareduringnormallabour,deliveryandimmediatepost-partum

24

8. ManagementofObstetricandNewbornComplica(ons 10

9. TeachingProcess 4

TOTAL 82

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Clinical Training ofHealth Care

Providers

First Action PlanImplementation

Revision of progressand continued

implementation ofaction plan accordingto needs identified in

quarterly internalassessments

External evaluationand recognition

Carry out standardsbaseline measurement

and conduct gap

analysis

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

Process Followed by each Model Maternity

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Health Professionals Trained

Since the beginning of MMIprocess (August 2009), 795

Health Professionals have

been trained:

q155 Trainers andPreceptors

q640 Service Providers(Doctors, MCH Nurses andSurgical Technicians)

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Model Maternity Initiative Monitoring and Evaluation

System

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q Quarterly Measurement of Quality Standardsq Monthly analysis and report of selected indicatorsUse of Active Management of Third Stage of LaborUse of Mg sulfate for severe pre-eclampsia / eclampsiaPartograph completely filled outPresence of a labor companionPresence of birth companionBirth in vertical/semi-vertical positionSkin to skin contact, mother to newborn

Immediate breastfeeding

Since January 2012: MMI Indicators are included in the National

Health Information System

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Institutionalization of Quality Improvement and

Humanization of Care

The institutionalization process includes thecreation 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

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QualityStandards:ComparisonbetweenBaselineandLast

Measurement

Datafrom28HealthFacili(es

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Quality Standards: Comparison Between

Baseline and Last Measurement

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Datafrom28HealthFacili(es

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C i B t Q lit St d d

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Comparison Between Quality Standards

Achieved in the Area of Humanized Care

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BeiraCentralHospital,2011

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Successful Approaches

qWorking together with pre-service training institutes and in-service trainers creates a more sustainable training process;qCreating a pool of trainers that also act as supervisors;qLetting provinces organize most aspects of the cascade

training helps them to grow;qIdentifying champions at central and provincial level is crucial

for the smooth implementation of interventions;

qBeing attentive and clarifying critical managerial and technicalissues along the way (eg, how to better organize labor anddelivery 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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JosMacamo

GeneralHospital

Maternity

Before

Aer

ModelMaternity

withthehighest

monthlyaverageof

deliveries=1070

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