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REDUCINGMATERNAL MORTALITY
A M AT E R N A L - C H I L D H E A LT H Q UA L I T Y I M P R O V E M E N T I N I T I AT I V E O F T H E
M I N I S T R Y O F H E A LT H A N D S O C I A L S E R V I C E S
I N C O O P E R AT I O N W I T H W I N D H O E K C E N T R A L H O S P I TA L / I N T E R M E D I AT E H O S P I TA L K AT U T U R A ,
I N T E R M E D I AT E H O S P I TA L O S H A K AT I
A N D H E A LT H Q UA L I N T E R N AT I O N A L
Launched in October 2013 to improve MCH quality of care and health outcomes, in order to reduce:____________________________________
Maternal mortality (phase 1)Neonatal moralityEarly childhood mortality
First Stage: Reducing Maternal MortalityWhy is this a concern?
Maternal mortality in Namibia remains too high.
U.N. Millennium Development Goal (MDG 5) calls for reducing maternal mortality by 75% from 1990 to 2015.
During this period Namibia’s maternal mortality rate actually increased, but is now decreasing.
We are back to the 1990 level.
Namibia’s maternal mortality rates (maternal deaths per 100,000 live births)
◦ Data source
1990 180 (The Namibian)
1992 224 (Baseline/UN)
2000 271 (WHO)
2005 310 (World Bank)
2006-2007 449 (WHO)
2008 180 (UNICEF)
2010 200 (World Bank)
2015 56 MILLENNIUM DEVELOPMENT GOAL
0
50
100
150
200
250
300
350
400
450
500
1990 1992 Baseline 2000 2005 2006-2007 2008 2010 2015 MDG GOAL
Maternal Mortality Rate: NamibiaMaternal Deaths per 100,000 Live Births
Medical concerns
Post-partum hemorrhage
Preeclampsia, eclampsia
Prolonged, obstructed labour
Puerperal sepsis
Pre-term and post-term deliveries
Ante-partum hemorrhage
Prior Ceasarean sections
Ectopic pregnancies
Abortion complications
HIV
Socio-demographic factors
Young patients
Late entry into antenatal care
Language barriers
Cultural barriers (patients’ reluctance to ask for help)
Patients lack funds to travel
Procedural concerns
Need for Standard Operating Procedures
Adherence to standards of care
Need for ongoing quality management processes
Delays in referring patients
Communication between facilities
Clinical operational concerns
Staffing levels
Staff training
Medication
Equipment
Supplies
Environment
Distance to health facilities
Availability of transport
Many factors contribute to maternal mortality.
Initial phase of MCH QI Initiative:
Focus, in order to have an impact soon. Focus on an area where we have some control. Maternal services (Labour and Delivery), where key medical issues arise.
Initially chose 4 SOPs—identified by MCH QI Committees of pilot sites (WCH/IHK and IHO):
Post-partum hemorrhage
Preeclampsia/eclampsia
Prolonged/obstructed labour
Puerpersal sepsis
Then the Committees added 2 more SOPs:
Post-term pregnancy
Induction of labour
The 29-31 July 2014 Tsumeb Workshop added 3 more, now under development:
Premature rupture of membranes
Antenatal hemorrhage
Managing patients with a previous caesarean section
Challenge: Where to start?
Recognize that future work will need to address:
Additional medical conditions.
Additional settings (all regional and district hospitals and health centers).
Non-medical factors (operations, procedures, patient empowerment, environment of care).
How are we are working in Maternity Services to reduce maternal mortality?
Nationwide:
- Defining standards of care
Asking each facility to:
- Create an MCH QI committee. (Initially meet monthly. Later, meet quarterly.)
- Measure performance through audit of patient charts, tracking data on the number and causes of maternal deaths. Establish baseline performance data.
- Implement improvement projects (PDSA). Set goal, analyze problem, test change, adopt successful strategies.
- Re-measure performance regularly (quarterly) to assess progress and drive improvement.
Laying foundation: MCH QM Committees at Windhoek Central/Katutura, and Oshakati
This initiative began in October 2013
Focused on 6 conditions related to maternal mortality
Drafted resources: SOPs, training materials, chart audit tools
Tsumeb Workshop to Finalise Maternal Standard Operating Procedures, 29-31 July 2014
13 Participants
Windhoek Central/Katutura Complex and Intermediate Hospital Oshakati
MoHSS Quality Assurance
MoHSS Maternal Child Health
HEALTHQUAL International
Finalised 6 SOP’s related to maternal mortality->
Tsumeb Workshop completed SOP’s on:
- Post-Partum Hemorrhage
- Preclampsia/Eclampsia
- Prolonged/Obstructed Labour
- Puerperal Sepsis
- Postterm Pregnancy
- Induction of Labour
They will be reviewed at a Ministry of Health meeting on 15 August and then distributed.
Also prepared: training materials (Power Point presentations, pre/post tests), chart audit tools, and resource manual/toolkit.
Among the future steps being pursued:
Complete 3 more SOPs: • Antepartum Hemorrhage, • Premature Rupture of Membranes, • Management when there was a previous Caesarean section
Roll out maternal mortality QI initiative in all district and regional hospitals—implement SOPs and ongoing QM process at each site.
Using SOPs as foundation to build ongoing MCH QM programs in each facility.
Future steps…
Then address other MCH concerns in a similar manner:
• Neonatal mortality
• Early childhood mortality
Acknowledgements
Maternity Services leadership and staff of Windhoek Central, Katutura and Oshakati Hospitals
Tsumeb GroupIntermediate Hospital Oshakati: Dr. Telmore Muti, Dr. Saara Kalume, SRN Diina Fernandes, SRN Ester Newaka, RN Ester Ikweya; Windhoek Central Hospital/Intermediate Hospital Katutura Complex: Dr. Albertina Amupala, Sr. Veripunia Katjatenja, Sr. Gerta Eichas, Sr. Cornelia Beukes Collie; Ministry of Health and Social Services: Ms. Christine Gordon, Dr. Apollo Basenero, Dr. Peter Sikana
Ministry of Health-Leadership: Dr. Forster, Deputy Permanent Secretary-QA Unit: Mrs. Gordon and Dr. Basenero-Maternal-Child Health Unit: Dr. Sikana
Thank you
for your commitment to improving maternal-child health.