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

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

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 i n 1990 to 408/100.000 LB in 2011  NMR: 59 in 1990 to 30/1000 LB in 2011 3

4. 4 Model Maternity Initiative General Objective: Transform the selected Maternities to centers of quality and humanized care provision and teaching in MNH. MMI is implemented through an approach that: 4  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.

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

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

7. Type of Health Facilities # of current HF Included in the MMI Process Total # of HF of each type in Country (HIS, Dec 2011) Central Hospitals33 Provincial Hospitals77 General Hospitals5 7 (5 with Maternity) Rural and District Hospitals 33 39 (33 with Maternity) Health Centers Type I and A 47 193 (130 – with 6 or more Maternity beds) TOTAL 95249 Health Facilities included in the MMI Process 7

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

9. Nº of AREAS AREAS DESCRIPTION Nº of QUALITY STANDARDS 1.Management of Maternal & Neonatal Services 8 2.Information, Monitoring and Evaluation 5 3.Resources: Human, Infrastructures and Commodities 4 4.Humanization of work conditions and safety 8 5.Health education and Community involvement 4 6.Humanization of Pre-Natal and Post-Natal Care 14 7. Humanization of Care during normal labour, delivery and immediate post-partum period 24 8.Management of Obstetric and Newborn Complications 10 9.Teaching Process 4 TOTAL81 9 MMI Quality Improvement Process  SBM-R

10. Quality Improvement Process at Health Facilities 10

11. 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) Main Results

12. 12 MMI Standards Measurements in 60 Maternities

13. Trends of Selected Humanization Indicators - MMI

14. Selected Humanization Practices: Urban VERSUS Rural Areas 14

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 15

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

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

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

19.  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; Lessons Learned

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