Maternal & child centers of excellence: Boosting provider motivation & improving health outcomes

The USAID-funded Maternal and Child Centers of Excellence (COEx) project works with the Dominican Republic's MOH to reduce maternal and neonatal mortality. With a focus on enhancing intrinsic motivation and ownership,. providers and managers were trained on emergency obstetric and neonatal care, customer service, biosafety and infection prevention, and use of management information systems.

The project developed 10 public hospitals as COEx to create a cohort of positive deviants that would both demonstrate impact on morbidity and mortality indicators, and share best practices and lessons learned with other hospitals nationwide. A system of 18 standards and competitive scoring was used to measure each facility's progress towards certification as a COEx.

As a result of the intervention, use of active management of the third stage of labor ( increased from 32% to 95% and maternal deaths decreased from 201 in 2010 to 168 (-16.4%) in 2011. The number of maternal deaths at the 10 intervention hospitals was cut by 49.2% as tracked by the MOH epidemiological surveillance system.

Conclusions: It is possible to develop an environment that nurtures intrinsic motivation in provider teams. A structured certification system harnessed motivational forces that promoted both clinical and managerial behavior change, resulting in tangible health impact. In 2012, the project was selected as one of only four projects highlighted at a joint US Senate joint USAID event featuring countries that have made significant advances in reducing maternal death.