Quality Improvement in Mozambique’s Model Maternities: Linking improvement in standards with health outcomes and respectful care

The initiative aimed to improve the quality of maternal and newborn care in 34 model maternities, which account for 22% of all institutional births in the country. The MMI used a comprehensive and integrated approach to quality improvement, focusing on technical aspects of care, as well as client-oriented aspects, such as treating clients with respect and dignity. The initiative integrated several key interventions, including ANC, essential obstetric care, newborn resuscitation, and postnatal care, among others. The MMI also tracked eight key indicators, including the use of MgSO4 for severe pre-eclampsia/eclampsia, the presence of a labor companion, and immediate breastfeeding. An analysis of 28 MMI facilities showed definitive improvement in eight of the nine quality areas, with significant gains in indicators of respectful care, newborn care, and maternal care. The institutional maternal mortality ratio dropped by over 50% in the first 24 months of the initiative, from 570 per 100,000 live births in 2009 to 286 in 2011. The MOH, with the assistance of MCHIP, continues to expand the MMI to expand to 125 health facilities by 2014, covering over half of all institutional births in the country. The MOH has also rolled out new registers that include key indicators and morbidity and mortality data, allowing for more exact analyses correlating quality, practice indicators, and maternal mortality. The ongoing challenges to quality improvement include infrastructure and commodity constraints, human resource constraints, and inconsistent use of data to improve quality. The MOH response includes minor repairs, training on forecasting, and establishing facility-co-management committees to motivate improvement. The MMI has shown promising evidence of improvement in standards, practices, and mortality. The initiative has demonstrated the effectiveness of a comprehensive and integrated approach to quality improvement, highlighting the importance of respectful care, newborn care, and maternal care in reducing maternal mortality.