Promoting Respectful Maternity Care in Mozambique

The initiative began with a facility-level analysis that revealed compromised quality of care, including problems related to long waiting times, lack of welcoming reception, poor privacy, and mistreatment of clients. The MOH engaged a broad range of community representatives and other stakeholders to develop strategies to address these problems. The MOH initiated the implementation of the National Plan to Improve the Quality of Reproductive Health and Child Health Services in 2007. This plan utilized a quality improvement methodology developed by Jhpiego called Standards-Based Management and Recognition (SBM-R), which incorporated aspects of evidence-based care, including RMC, into performance standards. The implementation of a quality improvement process that focused on respectful, evidence-based care in maternal and child health services was initiated in 18 health facilities in six provinces. The Model Maternity Initiative (MMI) was launched in 2009, expanding the quality improvement process to the 34 largest hospitals throughout the country. MMI promotes birthing practices that recognize women's preferences and needs, including respect for beliefs, traditions, and culture, and the right to information and privacy. The initiative also promotes the scaling-up of high-impact interventions, such as respect for the client's cultural background and the provision of care for birth in a more upright position. The implementation of MMI includes establishment of performance standards, provider training, baseline and systematic assessments in target facilities using the established standards, development and implementation of action plans, and recognition of progress. Health facilities in the MMI also track several key outcome indicators for maternal and newborn health (MNH) care. Graphics show the results for some of these indicators, including the evolution of coverage of partograph, use of magnesium sulphate, and active management of the third stage of labor. The culture of promoting RMC has become more widespread in Mozambique, with increasing involvement of pre-service and in-service training institutions, professional associations, and civil society. The MOH, with the support of MCHIP and other partners, is now working to scale up the MMI to include more than 122 health facilities by 2014.