Quality, Humanized & Respectful Care for Mothers and Newborns: The Model Maternity Initiative

1. Quality, Humanized & Respectful Care for Mothers and Newborns:The Model Maternity Initiative

2. Presentation Outline 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 • Background, Concept and Approach to Improve Quality, Humanized and Respectful Care; • Key Results: Service Delivery, Humanization & Respectful Care Selected Indicators; • Lessons Learned;

3. 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 1990to 408/100.000 LB in 2011 • NMR: 59 in 1990 to30/1000 LB in 2011

4. Model Maternity Initiative General Objective: Transform the selected Maternities to centers of quality and humanizedcare provision and teaching in MNH. MMI 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 scaling-up of evidence-based high-impact interventions. 4

5. Promotion of humanized birthing practices, which recognize women’s rights, preferences and needs:

6. Scaling-up high-impact, evidenced-based interventions:

7. Health Facilities included in the MMI Process

8. MMI Quality Improvement Process Is based on the SBM-R approach, 4 main steps:

9. MMI Quality Improvement Process  SBM-R

10. Quality Improvement Process at Health Facilities 10

11. Main Results From 2010-June 2013: 1161 Health Professionals were trained: • 155 Trainers: • 33 National Trainers • 90 Regional Trainers • 32 Tutors from training Institutes • 1070 Health Providers (Doctors, MCH Nurses and Surgical Technicians)

12. MMI Standards Measurements in 60 Maternities

13. Trends of Selected Humanization Indicators - MMI

14. Selected Humanization Practices: Urban VERSUS Rural Areas

15. Area 7: Humanization of Care during Normal Labour, Delivery and Immediate Post-Partum Respectful Care Demonstrated by the Health Care Provider Data from 10 randomly selected Maternities

16. Model Maternity Initiative - Trends of Selected Maternal Health Indicators

17. MMI has had an impact on the attention provided to Mother and Newborn at Country Level All Maternities (MMI and Non MMI) – HIS 2012 17

18. Improving Quality & Respectful Care Is a journey with many challenges, however to find sustainable ways to overcome them, all partners should walk this journey together!

19. Lessons Learned • 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;

20. José Macamo General Hospital Maternity With the highest monthly average of deliveries = 1100 Before After 20

21. Ghana Male involvement at Birth – from the national DHIS

23. Discussion:What RMC indicators should be tracked routinely?How would they be measured?