Improving the quality of maternal and child health care in Mozambique: Progress, challenges and lessons learned

In 2006, the Mozambique Ministry of Health (MOH) developed a National Plan to Improve the Quality and Humanization of Maternal and Child Health (MCH) Services that adopted a quality improvement methodology developed by Jhpiego. This methodology, called Standards-Based Management and Recognition (SBM-R), is a practical approach that calls for continuous learning, self-assessments, internal and external evaluation, and recognition of progress. SBM-R follows four main steps: 1. Setting performance standards based on national norms and international references; 2. Implementing standards through a systematic methodology; 3. Measuring progress to guide improvement toward standards; 4. Recognizing achievement of the standards. The MOH initiated the quality improvement process in 18 health centers. Facilities doubled their performance in the first six months of implementation of standards, and nearly tripled their performance after one year. These facilities are now operating at a higher level, adhering to updated, approved, and evidence-based standards. As a result, the MOH expanded the quality improvement process in 2009 to 34 additional facilities. This program is called the Model Maternity Initiative, which is spearheading a nationwide dissemination of quality improvement of MCH services. Key recommendations from the Mozambique experience include: • Invest in recognition of accomplishments as a motivating factor. • Expand new processes with a step-by-step approach. Improving the quality of MCH care is critical not only to increase service utilization and ultimately save lives of women and children, but also to affirm the rights of women and communities to quality and humanized services.