1. 3 rd International Conference on the Humanization of Childbirth Care (In Brasilia/Brazil - November 26 th -30 th ) Presentation on Washington-DC January 13, 2011 - 12:00-13:30 Presenter: Veronica Reis, MD, MPH – Jhpiego/MCHIP

2. Purpose of the Session  To share key points from the 3 rd International Conference on the Humanization of Childbirth Care held in Brasilia/Brazil on November 2010.  To share an abstract we presented on the Conference. 2

3. The 3 rd International Conference on the Humanization of Childbirth Care  Organized by REHUNA (Brazilian Network for the Humanization of Childbirth), supported by JICA and others  Purpose - to addressed relevant MNH issues such as:  Guarantee of SR rights through the humanization of MNH care  Reduction of maternal and perinatal morbidity and mortality  Promotion of appropriate use of drugs and technology in obstetric and neonatal care 3 MCHIP/Moz team

4. Objectives of the Conference  Spread and deepen the knowledge about the Humanization of Childbirth Care  Discuss new concepts and experiences on the physiological birth in different cultures and societies  Share experiences, best practices and lessons learned  Sensitize new partners on this issue  Promote the development of public policies in support of the humanization of childbirth care 4

5. Participants on the Conference  Health professionals, public health specialists, traditional birth attendant, physical therapists, social workers, social scientists, doulas, educators, managers, health service clients, pregnant women and their families, women's organizations, the media and others.  Total of approximately 2000 from 25 countries (Brazil, Argentina, Ecuador, Uruguay, Paraguai, Chile, Bolivia, Venezuela, Puerto Rico, Mexico, USA, Canada, Dominican Republic, Mozambique, Angola, Madagascar, Cape Verde, Portugal, Greece, Hollanda, England, France, Cambodia, Japan, New Zealand.) 5

6. Major themes of the Conference  The International Mother-Baby Friendly Childbirth Initiative  Intercultural health systems  Legislation in favor of the humanization: What exists and how to advance?  Care for delivery at home  Comparative studies about local of delivery  C-section: the appropriate and unnecessary use  Participation of partner and companion in the process of care in pregnancy and childbirth 6

7. Major themes of the Conference  Psychological aspects of pregnancy and normal delivery  Humanizing attention to pathological newborn  The impact of humanization of childbirth care on the breastfeeding  Training professionals for the new model of childbirth care  Institutional violence in obstetric care  National Partnership for the Reduction of Maternal and Child Health Mortality  Sharing experience of countries on panels and posters 7

8. Main Articles presented on the Conference http://www.tempusactas.unb.br/index.php/tempus/issue/view/87 Vol. 4, No 4 (2010) ReHuNa - Rede pela Humanização do Parto e Nascimento 8

9. General Concepts Shared  “Humanization of Childbirth” is an approach that:  centers on the individual;  emphasizes the fundamental rights of the mother, newborn and families;  promotes evidence based practices that recognize women’s preferences and needs; 9

10. General Concepts Shared (cont)  Humanization of childbirth care movement promotes:  respect to beliefs, traditions and culture;  continuity of care;  the right to information and privacy;  choice of companion during labor and delivery;  liberty of movement during the labor;  choice of position for delivery;  contact of the newborn skin-to-skin with the mother; 10

11. General Concepts Shared (cont)  Humanization of childbirth care movement promotes (cont):  mutually respectful and collaborative relationship among all types of care providers;  appropriate use of technology and effective lifesaving interventions;  Avoiding overuse of drugs and technology such as oxytocin augmentation, episiotomy, unnecessary cesarean section, etc.  Prevention of institutional violence against woman 11

12. Meetings with relevant stake holders  Meetings with relevant stake holders from several countries to discuss the progress and challenges of Humanization of Maternal and Neonatal Health Care process in America and Africa (Nov 29 th and Dec 1 rst ) 12

13. Main Observations and Comments from the Conference and meetings  The humanization of childbirth care is a movement advancing slowly but progressively in several countries.  Some Organizations and Network supporting this movement: JICA, RELACAHUPAN/ Latin-American and Caribbean Network for the Humanization of Childbirth; REHUNA/Brazilian Network for Humanization of Childbirth, Universities, ONGs, etc.  Regarding to Africa: presented the Madagascar-Japan- Brazil partnership to promote the humanization of childbirth care in Madagascar, and the Mozambique experience was also presented. 13

14. Main Observations and Comments (cont)  The International MotherBaby Friendly Childbirth Initiative (IMBCI) favor the humanization of MNH care and its implementation should be promoted;  The Mozambique team showed interest in having this Initiative implemented in country;  It´s important to do advocacy and disseminate evidence related to best and humanized practices in MNH care; 14

15. Main Observations and Comments (cont)  The multi-professional work is very important for the humanization of care;  Countries should conduct studies on women’s preferences and other aspects related to humanization of care during pregnancy, labor, deliver and neonatal care;  The knowledge from traditional birth attendants should be considered and valued as an important resource to better understand the birth process in the cultural context; 15

16. Main Observations and Comments (cont)  Community and media involvement it’s very important in this process;  Countries should promote national and regional conferences/events on the humanization of childbirth to disseminate research results, evidence and to share experiences;  It’s necessary to mobilize resources to support the implementation of the humanization of MNH care. 16

17. ABSTRACT - TWO SIDES OF THE SAME COIN: Report of Successful Experience Working to Improve Quality and Humanization of Maternal and Neonatal Health Care in Brazil and Mozambique Author and presenter: Veronica Reis, MD, MPH – Jhpiego/MCHIP Collaborators: Nazir AMADE (MOH Mozambique), Debora BOSSEMEYER, Maria da Luz VAZ, Humberto MUQUINGUE (Jhpiego/MCHIP) BrazilMozambique

18. General Information 18 BrazilMozambique Independence18221975 Population185.712.713 inhab.(Censo 2010) 20 069 738 inhab. (2007) GDP per capita/ USD 10 296 (2009)897 HDI (2010)0,6990,284 Life expectancy at birth 72,4 years45 years Literacy rate90,0 %38,7% Infant Mortality rate/ 1000 live births 20,0 (2007 – DATASUS) 124 Maternal Mortality ratio/ 1000 live births 77,0 (2007 – DATASUS) 408 (DHS 2003)

19. Government Initiatives Brazil: “National Program for the Humanization of Childbirth” 2004 - “National Pact for the Reduction of Maternal and Child Health Mortality” Mozambique: 2007 - “Presidential Initiative for the health of Mother and Children” 2009 - “Integrated Plan for the Achievement of MDG 4&5” and National Plan for Quality Improvement and Humanization of Health Services”

20. Similar Strategies  Training personnel of maternities to develop and implement plans targeting quality improvement and humanization of health services;  Guarantee of supervision and technical and material support;  Establishment of mechanisms for recognition of progress.

21. Similar Strategies Mechanisms for progress recognition:  Brazil: “Galba de Araujo prize” – Since 1999, given periodically for the better maternity by region. The hospitals were awarded the value of approximatelly USD 25,000.00, a trophy, a certificate and a commemorative plaque at a ceremony in Brasilia.  Mozambique: use SBM-R (standard based management and recognition) approach – recognition based on performance. 21

22. Investiment made by Brazil  Brazil has invested in provision of national and regional training for professionals from maternities of the entire country, in 2006 reaching a total of 2657 people trained from 550 maternities.  These maternities developed and are implementing projects for quality improvement and humanization of services.  Galba de Araujo prize - 05 awards were made: 1999, 2000, 2002, 2004 and 2006 with 25 HF Winning. 22

23. Progress and Chalenges in Mozambique  National Plan to Improve the Quality and Humanization of Maternal and Child Health (MCH) Services: implemented since 2006 using a quality improvement methodology developed by Jhpiego: Standards- Based Management and Recognition (SBM-R). MS Moçambique

24. Steps from Standards-Based Management and Recognition (SBM-R) approach

25. 2007-2008: Quality improvement process in 6 Provinces / 18 HC Results:  By the end of 2008 Facilities doubled or tripled their performance, were operating at a higher quality level, and were adhering to established evidence- based standards.

26.  Considering the results achieved, the MOH expanded the quality and humanization improvement process in 2009 to the 34 largest hospitals throughout the country, through the initiative called “Model Maternity”. 2009-2010 – “Model Maternities Initiative”: MCHIP Mozambique Manjacaze Hospital - Gaza

27. Humanization of Health Care Model Maternities Initiative (MMI)  The MMI is part of the National Plan for the Humanization and Quality of Health Care launched by MOH in July 2009  MMI General Objective:  Transform selected Maternities in quality and humanized care provision and teaching centers.

28. The MMI promote practices that recognize women’s preferences and needs…

29. …And scaling-up of MNH high-impact interventions:

30. MMI Standards by Area and M&E Selected indicators ÁREASCONTENTS STANDARDS 1.Managment 9 2.Information, Monitoring and Evaluation 5 3.Human and Material Resources 4 4.Health work conditions 6 5.Health Education and Community envolvment 4 6.Antenatal and Post-natal Care 11 7.Labor, Delivery and Neonatal Care 25 8.BEmONC 9 9. Training 4 TOTAL OF STANDARDS 79 MNH Result Indicators Selected 32

31. Key Result Indicators for M&E of MMI IndicatorBaseline (2009)MCHIP Target (2010) % of pregnant women who received at least 2 doses of IPT 51%61% % of HIV+ pregnant women who received prophylaxis (PMTCT) 45%60% Number of births by SBA on the selected Model Maternities 113,70410% above natural growth* % of deliveries with partograph completely filled 050% % of newborns with skin-to-skin care and early breastfeeding 050% % of birth with AMTSL050% % of severe pre-eclampsia and eclampsia treated with MgSO 4 <20%40% Source for baselines: NHIS, 2010 *Natural population growth:2.4%

32. MMI Implementation Process

33. Progress Achieved on IMM - Training in cascade: Nº of Trainings Kind of Training Nº of Health Professionals Trained 1National Training of Trainers29 3 Regional Clinical Training of Health Professionals for all provinces 90 10Provincial trainings of Health Professionals277 Total Nº of Health Professionals 396

34. Up to now all 34 selected HF carried out their Quality Baseline (ranged from 7.9% to 55.3%) and developed and is implementing its Action Plans 34 Photos: MCHIP Mozambique

35. Nampula Central Hospital 35

36. Nampula Central Hospital (2) Main Result Indicators

37. Conclusion  The experience of Brazil and Mozambique has demonstrated:  the value of the "political will" in favor of quality improvement and humanization of health services, and  the benefit of link investment in training to other mechanisms such as: accountability for the implementation of action plans after training; ensuring the supervision and the implementation of recognition.

38. Where There is a Wish... There is a Way! THANKS!