Reducing maternal and infant mortality in Belize

BelizeBelmopan, Belize

Organization type:

government

Project Stage:

Established

Budget:

< $1,000

Website:

http://health.gov.bz

Project Summary

Elevator Pitch

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

We have instituted a quality improvement initative to decrease maternal/infant morbidity and mortality in Belize.

About Project

Problem: What problem is this project trying to address?

As part of its global commitment to the United Nations Millennium Development Goals, the country of Belize has focused efforts on reducing its maternal and infant mortality rates. Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. The maternal mortality ratio represents the risk associated with each pregnancy, i.e. the obstetric risk. In 2008, the MMR worldwide is at 260 per 100,000 live births (LB), developing regions 290 and LAC Region 85/100,000 LB. For Belize the MMR reported for 2008 is 94/100,000 LB. The Belize MMR for 2010 is 53.9/100,000 LB similar to Cuba’s MMR in 2008.

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

In August 2009, the country of Belize implemented Pan-American Health Organization/World Health Organization (PAHO/WHO) evidence-based obstetric protocols in all hospitals in Belize. These protocols detail best practices during pregnancy, childbirth and post-natal care. In addition to the implementation of protocols, an audit process was instituted by the Ministry of Health, Belize. Each month, ministry staff visited each hospital in each of the 6 districts and conducted chart reviews, use of the protocols and collected data on adverse obstetric outcomes. This quality improvement initiative, in hospitals where use of the tools has been embraced, has resulted in a number of successful outcomes. Among them, better management of complications, decreased incidence of morbidity and mortality, more cohesive teams caring for mothers and infants, better communication among primary care practitioners and an accepted, structured, evidence-based decision-making model.

Impact: How does it Work

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

Prior to the improvement initiative, hospitals managed pregnancy, childbirth and antenatal care based on individual clinicians’ knowledge, skills and experience. What we did: i. Ministry of Health and the six health districts came together to define standards, indicators and monitoring tools to be used in the quality improvement initiative, drawing on tools developed in Nicaragua. ii. Training of stakeholders in standards, indicators and monitoring tools iii. Issued a maternal and neonatal care policy iv. Quality improvement team established at each hospital, consisting of, matron (nurse manager), 2-3 midwives and a public health nurse. v. Instituted data collection on adverse birth/obstetrical outcomes vi. Outcome with the lowest score was the priority for intervention the following month. vii. Monthly auditing viii. Peer coaching implemented ix. Forms to collect missing data in medical records developed x. The partograph form was revised; recommended to be the only form to document progress of labor xi. The midwifery form was reduced by eliminating duplication of information already on the partograph, simplifying the perinatal record. xii. Spreadsheets containing information on indicators by month (numerator, denominator and indicator value) filled on a monthly basis xiii. Graphs depicting each indicator was developed and updated on a monthly basis - visual of performance xiv. Analysis of information and plan of action based on results was shared with local management teams xv. Liaison with head of units to address specific situations

Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Addressing maternal and infant mortality in Belize requires everyone’s efforts. We do not work in competition with other organizations; we work collaboratively together to address the issue. Strong advocates of the introduction of this quality improvement initiative include primary care practitioners at the local level – nurses, matrons, sisters, midwives, public health nurses, community health workers, and physicians. Nationally, the Ministry of Health works closely with the National Women’s commission, University of Belize, and network of regional/community hospitals. We are also pleased to work in close collaboration with our international partners including, USAID Health Care Improvement, the Pan-American Health Organization/World Health Organization, UNICEF, and others.

Team

Founding Story

Our quality improvement initiative was launched in August 2009. Over the course of the following 18 months, it became clear that primary care providers, especially in Southern Belize, were embracing the new method of decision-making and management of obstetric patients. Teams active in the quality improvement initiative were communicating better, administrative changes created better patient satisfaction and, an improvement in maternal/infant morbidity and mortality occurred. In addition to this, the part that we hope to share with the world is that, these gains were all achieved without additional financial resources. By capitalizing on existing, passionate, dedicated and competent human resources in health care in Belize - we were able to show a decline in adverse outcomes in women and children.

About You

Organization:

Belize Ministry of Health

About You

First Name

Natalia

Last Name

Largaespada

Twitter URL

Facebook URL

About Your Organization

Organization Name

Belize Ministry of Health

Organization Country

, Belmopan

Country where this project is creating social impact

How long has your organization been operating?

More than 5 years

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Innovation

How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Cost.

Social Impact

Please describe the goal of your initiative; outline what you are trying to achieve

Our goal in Belize is to meet, and exceed, the target set in the United Nations Millennium Development Goals, to reduce by three-quarters by 2015 maternal mortality ratios and to reduce by two-thirds by 2015 the under-five mortality rate in Belize.
In addition, we also hope to improve the patient experience in labour and delivery in Belizean hospitals and improve communication/collaboration between primary care providers in the country.

What has been the impact of your solution to date?

Stories have unfolded of how nurse managers (‘Matrons’) noticed an immediate change due to small interventions, for example, moving the labour and delivery unit together and away from other wards created team cohesion and facilitated communication. They noticed increased communication and collaboration as the quality improvement team came together to assess progress – successes, ‘near misses’ and failures. And, as one participant in the initiative noted, ‘Quality improvement in maternal and neonatal care is measurable’; quantitative data also supports the success of the intervention. For example, a decrease in maternal hemmorhage rates occured in Punta Gorda hospital from Aug 2009 - Dec 2010, following implemementation of the initiative.

What is your projected impact over the next five years?

We hope to expand this quality improvement initative to all hospitals in Belize. We hope to meet or exceed the Millenium Development Goals related to maternal/infant health -- an ideal state would be zero preventable maternal and infant deaths in Belize.

What barriers might hinder the success of your project? How do you plan to overcome them?

The main barriers to this quality improvement initiative are two-fold, 1) Some primary care provider’s lack of willingness to ‘buy in’ to the quality improvement initiative, which is a new way of delivering care and 2) The lack of resources (human, financial, medical equipment) in Belize. We plan to overcome these by continuing to engage primary care practitioners, specifically through having an eager "champion" of the initiative in each institution. Lack of resources is an ongoing challenge in developing countries and not unique to Belize. Efficient use of existing resources is most effective.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Milestones: Increased compliance to the use of the quality improvement tools in districts other than the South of Belize

Identify three major tasks you will have to complete to reach your six-month milestone

Task 1

Workshop with quality improvement teams in Northern Belize

Task 2

Increase the number of pregnant women in Belize accessing prenatal care

Task 3

Analysis of adverse birth/obstetric outcomes – including the ability to brainstorm solutions to problems with providers.

Now think bigger! Identify your 12-month impact milestone

Elimination of maternal/infant mortality in Belize

Identify three major tasks you will have to complete to reach your 12-month milestone

Task 1

More midwives practicing in Belize

Task 2

Recruitment of a neonatologist

Task 3

Improved links to community health workers to address births occurring in rural and remote villages

Sustainability

Tell us about your partnerships

Strong advocates of the introduction of this quality improvement initiative include primary care practitioners at the local level – nurses, matrons, sisters, midwives, public health nurses, community health workers, and physicians. Nationally, the Ministry of Health works closely with the National Women’s commission, University of Belize, and our network of regional/community hospitals. We are also work in collaboration with our international partners including, USAID Health Care Improvement project staff, the Pan-American Health Organization/World Health Organization, UNICEF, and others.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

We hope to target care providers in the country who have not yet embraced the initiative (primarily those in Northern Belize). Additionally, representatives from the private sector that participated in the most recent learning session recognized the effectiveness of the intervention and are now in the process of initiating the same in their health facilities.

What type of operating environment and internal organizational factors make your innovation successful?

Implementation of a quality improvement initiative in maternal and neonatal care worked in Belize. Through the introduction of a collaborative, comprehensive, objective, simple and easy to follow method, by staff at all levels, we achieved results. This project can be easily replicated in the remaining hospitals and polyclinics in Belize and, potentially, other developing countries around the world. Through the use of the model we have not only reduced morbidity and mortality; we have built capacity within the system.
This project was done with existing staff and resources available - not one extra penny was used to implement the initiative. Although there is shortage of staff countrywide, the message is clear; compliance with protocols improved maternal and neonatal health outcomes.

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