Improving the Quality and Outcomes of Obstetric & Neonatal Care in Rural Nicaragua
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(please excuse cross postings)
The USAID Maternal Health Technical Series Presents:
Dr. Oscar Nunez and Dr. Luis Urbina
of the Quality Assurance Project, Nicaragua
Thursday, February 22, 2001, 2:00 - 4:00 PM
Ronald Reagan Building (1300 Pennsylvania Ave., NW)
Room 2.09 D/E
If you would like to attend the presentation (seating is limited),
please RSVP to Sara Moussavi <smoussavi@pal-tech.com>
In 1998, maternal mortality in the departments of Jinotega and
Matagalpa, Nicaragua, averaged 321 deaths per 100,000 live births, 16
times the rate in neighboring Costa Rica in the same year. The Qual-
ity Assurance (QA) Project, with USAID assistance, is introducing
modern quality assurance techniques, adapted from the US health sys-
tem, to make better use of limited resources. Less than a year after
the program began, the number of maternal deaths in El Cua and Bocay,
the two districts in Jinotega where the QA Project is active fell
from ten in 1999 to three in the first ten months of 2000. This
represents a drop in the maternal mortality rate from 202 to 73 (per
100,000). It is too soon to be sure if this drop will be sustained,
but improvements in care are well established.
Initially, providers were largely unaware of national standards for
obstetrical care. Drs. Nunez and Urbina, two Nicaraguan physicians,
initiated and led a program of quality improvement which focuses on
issues of client satisfaction and improving compliance with national
standards for prenatal and delivery care. Service processes were re-
designed (for example, there is a special line for pregnant women
which has resulted in a total waiting and visit time of less than �
hour compared to 2 hours before the program began), health workers
were re-trained in the care of obstetric complications, and PAHO
perinatal technologies such as the partogram were introduced to fol-
low the women's labor and to identify danger signals.
The health center team monitors its own performance and compliance
with standards by reviewing a sample of records each month and posts
the results on a bulletin board outside the centers for both staff
and clients to see. In only 10 months health center teams have in-
creased compliance with obstetric standards from under 3% initially
to between 70% and 90%. Patient satisfaction has increased from 58%
to 87%.
These changes were illustrated recently when a USAID team was visit-
ing a clinic when an obstetrical emergency happened to be brought in.
The woman had delivered a healthy baby at home, but experienced a re-
tained placenta (the leading cause of maternal mortality in Nicara-
gua) and was in danger of a fatal hemorrhage. A number of steps were
carried out effectively to save this woman's life: the traditional
birth attendant in the village was trained to recognize the problem
promptly, the mother was brought directly to the clinic, and at the
clinic, each step in the national standards for her care were fol-
lowed. By the time that the USAID team left the clinic, she was rest-
ing comfortably, breast-feeding her new baby.
Dr. Oscar Nunez: Dr. Nunez is a pediatrician who was Deputy Director
of the National Children's Hospital in Managua prior to joining the
QA Project. He has received training at the CDC in Atlanta in Quality
Management and had a long commitment to its implementation at the
Children's Hospital. He has also been the President of the Nicaragua
Society of Pediatrics. He acts as the QA Project Country coordinator
as well as being involved daily in implementing the QA program in the
field.
Dr. Luis Urbina: Dr. Urbina is an obstetrician with extensive experi-
ence in the practice and teaching of obstetrics. He received a Ful-
bright scholarship to study reproductive Health at Tulane University
and was Director of Profamilia's Regional Center in Managua. He is
dedicated to improving maternal care in rural Nicaragua and has been
involved in training TBA's in Nicaragua for UNFPA. As the full-time
Maternal Health Coordinator for the QA Project he has organized the
technical approach to assure the management of maternal care and com-
plications according to evidence based standards of care and by as-
suring the implementation of the PAHO Perinatal Technologies in the
five project districts in Matagalpa and Jinotega.
FOR MORE INFORMATION:
Donna Vincent Roa, Ph.D.
Director of Communication and
Associate QAP Project Director
Quality Assurance Project
7200 Wisconsin Avenue, Suite 600
Bethesda, MD 20814, USA
Tel: +1-301-941-8524
Fax: +1-301-941-8427
mailto:dvincent-roa@urc-chs.com
http://www.qaproject.org
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