Strengthening Rural Health Centers to Deliver Quality Reproductive Health Services Tambudzai Rashidi Eneud Gumbo Aleisha Rozario Fannie Kachale Chisale Mhango

2 Likoma Island Districts covered with PQI in Integrated IP and RH interventions MAP OF MALAWI

Background  Approximately 80% of Malawi's 13 million population resides in rural communities.  The majority of the Malawian Population in rural areas seek medical care in health centers  Limited human and material resources contributes to delays in providing comprehensive and quality care at health centers 3

Outline of Presentation  Goal of RH  PQI in RH/IP/PMTCT at Health Centers  Results  Assessment of impact  Conclusion 4

Goal of Reproductive Health  To improve the quality of reproductive health services by ensuring that comprehensive, integrated services are provided according to national standards of care. 5

Introduction of Performance and Quality Improvement Process  In 2002, the Ministry of Health (MoH) identified Infection Prevention (IP) as National priority to protect patients/clients, healthcare workers, the community, and the environment from nosocomial infections and improve delivery of health services.  This was done through Performance and Quality Improvement (PQI) processes following standard based management and Recognition (SBM-R) approach  To-date 35 Facilities are implementing PQI/IP. 6

Introduction cont.  In 2006 MoH started implementing PQI in RH in Selected Districts and Referral Hospitals following the success of PQI in IP  To-date 28 hospitals and 4 tertiary Hospitals are implementing SBM-R)  In 2008 PQI was launched following SBM-R in 13 health centers covering 4 districts after successful implementations of SBM-R in district and tertiary hospitals 7

Aim of SBM-R in Health Centers  Aim was to strengthen quality of services at first level facilities where 80% of Malawians receive primary care 8

PROCESS  Integrated operational performance standards for both Infection Prevention and Reproductive health for health centers level were developed in August- September 2008 for monitoring quality assurance  Identification of service providers and management to form a Quality Improvement Support Team (QIST) 9

Process cont.  The QIST in the health centers were trained in PQI modules 1 and 2 and Module 3 (November – December 2008 and April – June 2009)  Monitoring of service improvements done on a quarterly basis and annually at the national level  District-level stakeholder’s meeting conducted to review internal assessment results and share progress and challenges 10

Results of PQI process in health Centers- 11

Assessment of Impact of PQI intervention at Health Center level  MCHIP in collaboration with Reproductive Health Unit of Ministry of Health conducted an external assessment to document impact of PQI interventions  Assessment conducted in 4 of the 13 implementing sites and 2 non implementing sites  The integrated IP/RH standards were used in the documentation exercise 12

Impact continued  Health centers scored an average 56.6% (range 33%-65%) at follow-up in April 2009 compared to 34.3% (range 19-49%) at baseline the previous quarter and 23.7% for non practicing sites  All the implementing health facilities have shown increased adherence to standards compared to baseline 13

Impact cont.  All facilities were observed to be practicing active management of the third stage of labour (AMTSL) to prevent postpartum hemorrhage, the leading cause of maternal deaths.  Integration of PMTCT in RH services is now being offered routinely in postnatal care and family planning. 14

Comparison of intervention versus non-intervention PQI scores 15

PQI Scores by facility 16

Conclusion  All the health centers implementing integrated PQI IP-RH services showed improvement in the quality of care provided as compared to non intervention sites (45.9% vs. 23.7%, p<.01)  PQI IP-RH is a workable approach, use existing health systems (i.e. staffing, drugs and supplies) to improve quality of care.  PQI following SBM-R is critical in making n impact in the MDGs 4 and 5 17

Way Forward  Since PQI in IP/RH/PMTCT has proved to make a difference in the delivery of health services, there is need to scale up to other areas in order to improve the quality of RH services and make an impact in the MDGs 4 and 5  The Chairperson of NQATWG has directed that the interventions be scaled up to all the health centers in Malawi 18

In Closing I just want to say!!! Thank you! wwww.mchip.net Follow us on: 19