La Revolucion de Partos Humanizados - The Humanized Birth Revolution

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La Revolucion de Partos Humanizados - The Humanized Birth Revolution

Dominican Republic
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$500,000 - $1 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

The "Humanized Birth Revolution" improves health outcomes for women by promoting delivery in primary care, community-based facilities without extensive medical intervention. The project incorporates community engagement, improved doctor-patient relations, increased health decision-making power for women, exclusive and immediate breastfeeding, and socio-emotional support during labor and delivery.

About Project

Problem: What problem is this project trying to address?

The “Humanized Birth Revolution” is a project that empowers women to be key decision-makers during their pregnancy, labor and delivery, which improves health outcomes for mothers and their newborns. In the Dominican Republic (DR), over 98% of births are attended by health personnel, yet the maternal mortality ratio remains disproportionately high at 150/100,000 live births. The cause of this maternal health paradox has largely been cited as poor quality of labor and delivery care services as a result of poor training, lacking incentives, over-medicalization of birth (>25% c-sections) and overcrowding at large tertiary care facilities.

Solution: What is the proposed solution? Please be specific!

Through customized training, technical and financial support “Humanized Birth Revolution” promotes critical changes in doctor-patient relationships, health literacy and quality of health services provided to women and their families. We identify and support changemakers in community-based hospitals, who have often worked there for years but have not been in positions of authority. The project operates on three levels: At the community level, representatives from the surrounding communities serve on the hospital’s Quality Improvement Committee to ensure that patients’ voices are heard to improve services. Via community outreach, women learn about services, the benefits of a humanized childbirth and are sensitized to changes they should expect in the quality of labor and delivery services. At the patient level, women are coached through a humanized birth experience from their first prenatal visit. They work with providers to make informed decisions about their delivery based on the risk-level of their pregnancy and previous birth experiences. Women can deliver locally in a safe, clean environment where they receive socio-emotional support and are encouraged to be active decision-makers throughout their labor and delivery. Patients receive coaching on how and why to breastfeed and receive a follow-up home visit within 72 hours of delivery. At the provider level, doctors, nurses and staff receive peer education and on-the-job-training working with national experts to apply their knowledge in real-life situations. Providers are taught evidence-based practices for management of labor, deliveries and referrals for high risk while receiving incentives for compliance with humanized birth checklists. At all levels the project measures patient and provider satisfaction using the results of surveys to continuously improve.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

After the initial humanized birth training and refresher courses were implemented, staff at the Villa Fundacion Municipal Hospital reported feeling more confident in their clinical abilities to diagnose and deliver babies, and the number of deliveries has increased significantly. The number of deliveries taking place August to November increased from 10 (2008) to 56 (2009). 90% of women interviewed post delivery report that they would return to the hospital to deliver again and that they would recommend Villa Fundacion to friends and family. Staff reports increased satisfaction with their work, increased connection with patients and increased skills for delivery and appropriate referral. Patient and staff satisfaction evaluations documented the effects of the Humanized Birth Revolution occurring at Villa Fundacion. The results of patient satisfaction surveys and post-training evaluations correlate to higher demand for services due to improved quality, which in turn has led to increased provider satisfaction and deeper engagement of the Quality Improvement Committee. As the hospital’s reimbursement rates from the Dominican Ministry of Health are linked to the number of births attended, hospital revenue and provider incentives have both been increased. Thus, the synergies of the “Humanized Birth Revolution” have a demand-driven multiplier effect within the Villa Fundacion and the surrounding communities.
About You
Organization:
World Connect, Inc.
Section 1: You
First Name

Jacquelyn

Last Name

Caglia

Organization

World Connect, Inc.

Country

, MA

Section 2: Your Organization
Organization Name

World Connect, Inc.

Organization Phone

781 894 8050

Organization Address

681 Main Street; Waltham, MA 02454

Organization Country

, MA, Middlesex County

Your idea
Country and state your work focuses on

, PR

Innovation
Do you have a patent for this idea?

Impact
Actions

World Connect works in horizontal relationships with its partners with the understanding that local solutions to local problems always work best. The support provided to Villa Fundacion Hospital draws off of existing institutional capacities, strong relations with the Dominican Ministry of Health and a cadre of changemakers within the hospital and surrounding communities who are committed to improving maternal and neonatal healthcare. To foster sustainable changes, we assist with the formation of quality improvement teams led by local champions.

World Connect equips hospital and referral health clinic staff with the tools, training and resources they need to successfully save and improve the lives of mothers and their newborns. We work with identified changemakers to improve maternal and neonatal services at the facility level. We train physicians, nurses and community health workers; provide appropriate equipment and facility upgrades; and improve hospital systems to promote quality, which will ultimately lead to a reduction of maternal and newborn mortality and morbidity.

Results

The "Humanized Birth Revolution" is demonstrating its effectiveness at the facility level within the Villa Fundacion Hospital. Working with local stakeholders and partners, we are creating a center of excellence for labor and delivery at Villa Fundacion that will be a model for other municipal hospitals within the DR and other Latin American countries supported by World Connect based on the following expected results:
• Skilled and equipped healthcare providers who have received evidenced based training to health utilizing technologically appropriate equipment and are capable of modeling clinical care
• Engaged provincial leaders within community health sector in the DR who have identified areas of need and feel empowered to make necessary changes
• Strengthened relationships between communities, hospitals and health clinics
• Enhanced focus on family-centered care; are capable of providing high quality humanized birth services in a welcoming environment with appropriate referral of high risk cases
• Strengthened data for decision-making based on improved data collection practices and interpretation
communities are armed with knowledge to address health concerns

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

For the “Humanized Birth Revolution” to be considered a success the project needs to build off the foundation put in place during the current pilot phase. The Villa Fundacion Municipal Hospital will need to move further towards becoming a center of excellence for humanized birth practice. Progress will be incremental focusing in year one on the meeting all of the facility-based criteria for training, equipping and functionality of the Quality Improvement Committee. During year two, the hospital will turn its focus on satellite referral clinics and strengthening relationships with the regional and national Ministry of Health. In year three, the project will need to go scale within the Dominican Republic and serve as a training hub and clearing house for information on humanized birth within the country. Success at the end of year will be judged on the number of additional municipal hospitals working towards meeting the criteria to become centers of excellence for humanized birth. Some of the objectives along this continuum will be implemented simultaneously and adapt to situations on the ground as they develop.

World Connect believes that in order to promote sustainable change and improve maternal and child health, all components of humanized birth described in our expected results need to be present. However, this does not imply that we are responsible for implementing every component; rather we recognize that each one of the components needs to be addressed substantially by local changemakers. For the “Humanized Birth Revolution” to be successful we believe it must integrate a component of constructive accountability and encourage local ownership and oversight by clients and other members of the healthcare team who are associated with the delivery of care within a local health system. Building constructive accountability into health delivery programs is enhanced through the integration of community members into the management of health services. In order for the continuum of maternal, neonatal and childcare to be effectively provided and save lives, providers need to be well trained, available, motivated, and equipped with the necessary tools to provide standard care, address an emergency and refer appropriately.

What would prevent your project from being a success?

Working within an existing health system presents many opportunities, but also many challenges that must be addressed. Relationships must be based on respect and trust. We recognize that the “Humanized Birth Revolution” will only succeed with local support at the municipal, provincial and national level. A decrease of local buy-in at any one of the aforementioned levels could prevent the project from being successful. It is also essential to have community buy-in, when community involvement does not occur the project is missing a key asset which can be catalyzed to address obstacles and resolve problems. Also, a lack of support from the Dominican Government, particularly the Ministry of Health, would not allow the project to scale in the way it was designed.

How many people will your project serve annually?

1001‐10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Operating for less than a year

In what country?

, PR

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Villa Fundacion Municipal Hospital

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

Yes

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Partnerships are the foundation for a successful grassroots program. World Connect prioritizes building and strengthening existing partnerships with individuals, communities, institutions, and governments who have a stake and expertise to improve local conditions. We partner with institutions that support high quality maternal, neonatal and child health programming in ways that inspire domestic audiences to learn more about global health challenges and to take action. We engage with agencies and offices of the United States Government, such as the USAID Mission in the Dominican Republic and the Dominican Ministry of Health. Research has shown that horizontal partnerships based on respect tend are most fruitful. We believe partnerships with mutually agreed upon roles and responsibilities are more productive than those where one party is subservient to the other and this is how we will endeavor to work with partners and within local healthcare systems and at all project sites. Partnerships will occur at multiple levels for the project to be successful. There are partnerships with academic institutions, such as Harvard and Columbia who will continue to provide technical support.

What are the three most important actions needed to grow your initiative or organization?

1. Develop and maintain strong partnerships with local leaders, hospital staff and community members
2. Continuous evaluation of the project's progress to allow for on-the-spot learning and course corrections
3. Documentation of successful changes made at the provider, patient and community level in the short and long term.

The Story
What was the defining moment that led you to this innovation?

World Connect started working in partnership with Villa Fundacion Municipal Hospital in 2009 through its Infante Sano program. Staff and patients identified that one of the pressing needs felt by women in the community was the need to improve services for labor and delivery at the hospital. While the municipal hospital had the capacity for women to deliver at their facility, many women opted to seek services farther away at the larger provincial hospital citing a lack of quality services within their community. Many women whom should have had natural and normal births at Villa Fundacion, were being referred to the provincial Hospital in the city of Bani and often ending up with an unnecessary c-section and/or complications from a lack of cleanliness and poor labor and delivery practice. Traveling to the larger hospital led to overcrowding at the larger facilities and put women and their newborns in harm's way by adding delays for care during emergencies and created preventable complications. While our initial training and quality improvement interventions were at the larger, tertiary facility, we determined through this project that we are better able to make systemic improvements for more women by improving services at the smaller primary care hospitals at the community and municipal level, which also lead to improvements at the larger facility. This was a defining shift in the development of the “Humanized Birth Revolution”.

Tell us about the social innovator behind this idea.

The social innovators behind this initiative are Dr. Yulissa Campusano and Nurse Ana Baez who are both employed at the Villa Fundacion Municipal Hospital. They are the change agents leading the project within the hospital and also community members. They lead patient and community engagement efforts as well as coordinate training for the hospital’s staff. Yulissa and Ana also manage the hospital’s quality improvement committee charged with oversight of the project’s monthly progress.

How did you first hear about Changemakers?

Friend or family member

If through another, please provide the name of the organization or company

50 words or fewer