Applying the Improvement Collaborative model to influence national policy and implementation of evidence based maternal and newborn health practices in Niger

Africa leads the world in its rates of maternal and newborn mortality. Many maternal and newborn deaths are preventable with simple, evidence-based practices. For example, Active Management of Third Stage Labor (AMTSL) reduces post-partum hemorrhage by 50%, and Essential Newborn Care (ENC) can significantly reduce newborn mortality, a major contributor to early childhood mortality.

In Niger the Quality Assurance Project has applied the Improvement Collaborative model to rapidly improve quality of maternal and newborn care via adoption and implementation of Essential Obstetric and Newborn care (EONC) standards at national policy and local facility levels. In 2006 a national expert group facilitated the adoption of AMTSL and ENC standards for the first time in Niger. Adopted standards were then introduced into 28 facilities using the Collaborative model. In an Improvement Collaborative, teams from different sites work together intensively to share and apply strategies for rapidly implementing identified best practices.

In its first year of operation the EONC collaborative increased the % coverage of births with AMTSL in targeted facilities from 0 % (Jan 06) to 95 % (Dec 06), and increased the % coverage of births with immediate breastfeeding, a proxy for ENC, from 23 % to 91%. Compliance with new standards improved from 0% at baseline to 95% for AMTSL and from 17% to 79% for ENC. Post-partum hemorrhage rates decreased by 50%, from 2% at baseline to 1% of live births 6 months after implementation of AMTSL.

In Niger, the improvement collaborative has influenced donor and national political commitment to emerging maternal and newborn evidence based best practices by providing a model that translates policy into practice.