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URC’s Maternal Health Work in Ecuador Published in International Journal
The International Journal of Gynecology and Obstetrics (IJGO) published a new article by URC researchers this month. Co-authored by Dr. Jorge Hermida, Director of Latin America for the US Agency for International Development (USAID) Health Care Improvement Project (HCI), the article provides a compelling model for countries seeking to reduce the number of women who die each year during childbirth, estimated at nearly 400,000 globally. As in many other developing countries, the primary cause of maternal death in Ecuador occurs from severe bleeding in childbirth, or postpartum hemorrhage.
Research shows that postpartum hemorrhage rates drop by more than half when health workers perform a clinical practice called active management of the third stage of labor (AMTSL) immediately after delivery. AMTSL involves three steps: injecting a drug that reduces blood loss, carefully retracting the umbilical cord to remove the placenta, and massaging the woman’s abdomen. In Ecuador, most women go to health facilities to deliver, but most health facilities did not apply AMTSL until HCI and the Ministry of Health (MoH) introduced the practice in 2003.
The article, published in IJGO’s June issue, describes the introduction and rapid expansion of AMTSL in Ecuadoran health facilities, health centers, and hospitals over a six-year period. At the same time, HCI Ecuador staff advocated for including AMTSL in national health care guidelines with MoH officials. Using this twofold approach—facility-level implementation and national-level advocacy—the project galvanized support and impetus for action at both grassroots and national levels.
The project’s initial success convinced MoH decision makers to approve and include the contraction-inducing drug oxytocin in the MoH’s obstetric care standards in 2006. By the end of the project, 138 health facilities, 37 health centers, and 101 hospitals applied AMTSL to women under their care at least 90% of the time. Even as donor support waned at the end of 2008, this rate remained consistent, demonstrating that health facilities had institutionalized the practice.
Applying Continuous Quality Improvement for Better Care
To achieve these results, HCI applied a process called continuous quality improvement (CQI). Through CQI, facility-based teams of health care workers adapt, integrate into their regular work, and disseminate one or more best practices (in this case, AMTSL) by testing innovative ways to overcome specific obstacles. The teams regularly measure and evaluate their progress in complying with the best practice to identify when the practice is not used and why. The interaction of teams within and among facilities provides further motivation for improvement.
The MoH gathered and synthesized lessons learned during the CQI process by the teams of health workers and incorporated them into a National Campaign to Reduce Maternal Mortality.
The article suggests that public health practitioners and ministries of health can use CQI to introduce and scale up AMTSL and other best practices that would improve the health and welfare of people worldwide.
“Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador” is available on the IJGO website. An author-accepted manuscript is available in English and Spanish. See a press release on the article here.
May 29, 2012