162481 Improving systems of essential obstetric care in Ecuador, Honduras, and Nicaragua: Results and challenges

Tuesday, November 6, 2007

Jorge Hermida, MD , Quality Assurance Project, University Research Co. LLC-Center for Human Services, Bethesda Maryland, MD
Luis Vaca, MD , Ecuador, Quality Assurance Project/University Research Co., LLC, Quito, Ecuador
Bernarda Salas, MD , Ecuador, Quality Assurance Project/University Research Co., LLC, Quito, Ecuador
Luis Urbina, MD , Nicaragua, Quality Assurance Project/University Research Co., LLC, Managua, Nicaragua
Norma Aly, MD , Honduras, Quality Assurance Project/University Research Co., LLC, Tegucigalpa, Honduras
Lani Marquez, MHS , University Research Co., LLC, Bethesda, MD
The Quality Assurance Project worked with Ministries of Health in three countries to undertake a regional essential obstetric care (EOC) improvement collaborative from 2003-2005. The aims of the collaborative were to establish local EOC systems with improved compliance with standards for routine obstetrical care (prenatal and delivery) and management of obstetrical complications. The collaborative was successful in stimulating efforts at the national level to review and update standards of obstetric care and at the facility level to improve health worker competence and quality of routine obstetric care. Among other indicators tracked by the collaborative, correct use of the partograph rose from 40% to 87% of deliveries in participating facilities in Nicaragua; from 44% to 94% in Ecuador, and from 42% to 72% in Honduras. The practice of active management of the third stage of labor rose from 15% to 67% in Ecuador, from 69% to 100% in Nicaragua, and from 92% to 100% in Honduras. The original collaborative did not meet its goal of achieving significant gains in quality of care for the management of obstetric complications. A separate collaborative focused specifically on management of obstetric complications was started in Ecuador in 2006. The improvement collaborative approach is an effective strategy for achieving large-scale improvement, but a single collaborative broadly aimed can only address so many issues. To complement gains in routine basic essential obstetric care, specific improvement initiatives that focus mainly on obstetrical complications are needed to address quality of care issues that most directly affect excess maternal mortality.

Learning Objectives:
By the end of the session, participants will be able to: - Explain the key features of an improvement collaborative aimed at improving EOC care - Identify at least five interventions that public sector teams in the three countries have undertaken to raise the quality of prenatal and delivery care - Identify at least three key challenges to reducing maternal mortality through improving quality of care in public facilities

Keywords: Maternal Health, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Taking Care of Mothers
See more of: International Health