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7/29/2019 Institutionalization of Quality Improvement and Humanization of Maternal and Neonatal Care in Mozambique's National Model Maternities Initiative
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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
2
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
3
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
5
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
6
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
11
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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
13
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
15
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.)
16
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JosMacamo
GeneralHospital
Maternity
Before
Aer
ModelMaternity
withthehighest
monthlyaverageof
deliveries=1070
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