hermida: country experiences in delivering integrated maternal and newborn care

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Country experiences in delivering

integrated maternal and newborn

careDr. Jorge Hermida

Regional Director, LAC programs

The USAID ASSIST Project, University Research Co., LLC

Global Newborn Health Conference

JOHANNESBURG, SOUTH AFRICA. April 2013


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The situation before 2009

Maternal and child care managed from separateoffices in the Ministry of Health

Norms developed or updated separately

Initiative for Quality of Maternal Care but not forChild or Newborn Care

No coordination in delivery of care at facilitiesbetween obstetric and pediatric care and

personnel System for maternal mortality surveillance but not

for Newborn mortality


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Changes in 2009

Maternal and Child Care programs were unified and arenow managed from one single office at the MOH

Norms were updated and were issued jointly

A newborn care component was included within the

Maternal Quality Improvement Initiative, including trainingon evidence-based interventions both theoretical andpractical, quality standards, indicators, a monitoringsystem, and local QI teams implementing PDSAs andcontinuously improving care.

Joint QI teams for maternal and newborn care weremandated at every facility where births occur.

A Newborn mortality surveillance system was developedand issued.


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REFERRAL

BASIC EONC24 hours/7days

COMMUNITY EONC

COMPLETE

EONC24 hours/7days

TBAs

HEALTH CENTERS

COUNTY HOSPITALS (5)

ESSENTIAL OBSTETRIC AND NEWBORN CARE NETWORK, COTOPAXI

PROVINCIAL HOSPITALS (2)

Parish micronetwork:

TBAs, health centers and

social organizations working

together


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Field test in one of 24 provinces of Ecuador:

Expanding Access to both maternal and newborn care through a three-tiered EONC Network:

Community, Basic and Comprehensive ONC. TBAS, community organizations and health centers work together to identify pregnant women,

conduct home visits and refer women and babies to nearby county hospitals.

County hospitals provide integrated Basic EONC; provincial hospitals provide integrated

Comprehensive EONC.

Essential newborn care, HBB and Kangaroo Mother Care were introduced, standardized

management of preterm deliveries dexamethasone for fetal lung maturation, standardizedmanagement of PROM, complications such as infection, prematurity/LBW and respiratory

distress.

Integration happens horizontally between provider institutions including the MOH, the Social

Security facilities and provider NGOs .

Access to and quality of Maternal/Newborn Care are monitored monthly and quarterly at

facility and provincial aggregated levels. After 2 years of testing , results show model is feasible to implement and low-cost. Access in

terms of skilled attendance at birth, maternal-newborn complications identification and

referral, quality of care was improved. Newborn mortality was reduced in intervention areas

The MOH decided in late 2012 to scale up the integrated model to the entire country, mostly

using its own resources. Scale-up is currently underway.


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Key Challenges

Sense of property of programs at the MOH.

Hospital specialists who prefer to have their ownreign

Deficiencies in training on NB knowledge and skills ofdoctors and nurses

Legal and institutional difficulties to integrate MOH,Social Security and NGOs

Resistance to effectively integrate the TBA as a linkbetween the communities and the health system andas a direct community provider of services whenreach is not possible.


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Obstacles and failures

To integrate more strongly the civil society

organizations into an oversight and support for

improvement role.

To effectively introduce NB mortality (and nearmisses) surveillance as a regular task of district

management teams

To strengthen pre-service training on knowledge

and skills for integrated maternal and newborn

evidence-based interventions.

hermida: country experiences in delivering integrated maternal and newborn care

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