With Jhpiego’s Help, A Malawi Hospital Improves Reproductive Health Services for Women—Winning Accolades and A Prestigious Award

By Tambudzai Rashidi and Aleisha Rozario

When a review of reproductive health services at Mzuzu Central Hospital in Malawi found less than exemplary service, Director Rose Nyirenda was determined to address the challenges, improve patient care and motivate her staff to achieve their personal and professional best. She and a quality improvement team organized on-the-job training for all nurses, doctors and other clinicians to start narrowing the gaps in service.

The effort, carried out over 10 months and supported by the United States Agency for International Development (USAID), with technical assistance from Jhpiego, resulted in fewer maternal deaths and other significant improvements in patient care for women and newborns—and special recognition for the hospital as a Center for Excellence in Reproductive Health.

“You have made us proud, you are a role model hospital and we will encourage other hospitals to come and learn from your best practices and initiatives,” Deputy Minister of Health, Theresa Mwale, said at an awards ceremony held earlier this year.

The quality improvement program, part of a Ministry of Health initiative for government hospitals, focused on the quality of maternal health services in a dozen areas including management of normal and complicated labor and delivery, postnatal care of women and newborns, focused antenatal care (malaria prevention, HIV counseling and testing, syphilis screening), family planning, cervical cancer prevention services and management of sexually transmitted infections.

As part of the program, Jhpiego in collaboration with the hospital’s quality improvement team, conducted a baseline assessment of hospital reproductive health services against which improvements would be measured. Three months after that assessment, Mzuzu Central Hospital conducted an internal review to check their progress. The hospital met the standards in 74 percent of the target areas, an increase from the 50 percent at the baseline assessment. Inspired by the dramatic improvement in only three months, the hospital’s management team presented gifts and prizes to the six departments that scored above 80 percent.

Nyirenda and the hospital staff pressed on. In October 2009, a mere six months after the baseline assessment, the hospital reviewed its progress and recorded even more improvement. The hospital’s performance drew the attention of the Ministry of Health and, in December, a team from the Ministry conducted an independent verification of the hospital’s 12 maternal health service areas.

The MOH team found compliance on 89 percent of the standards, qualifying Mzuzu as a Center of Excellence in Reproductive Health service delivery. At a ceremony in February of this year, Director Nyirenda received the prestigious shield of excellence in recognition of the hospital’s success in achieving best practices in the delivery of quality maternal health care.

“We are the first central hospital to be recognized as a Center of Excellence in Reproductive Health,” Nyirenda said at the award ceremony attended by the Deputy Minister of Health and other dignitaries. “We are also the first hospital to be recognized following implementation of performance and quality improvement using the Standards-Based Management and Recognition (SBM-R) approach in a record 12 months.”

The successes achieved by Mzuzu’s staff and facilitated through Jhpiego’s SBM-R approach had a direct impact on saving women’s lives. Between 2004 and 2009, there was a 36 percent decline in maternal deaths related to labor and delivery. Improvements were found in early diagnosis and correct management of eclampsia and postpartum hemorrhage. “All our patients recovered fully including those with severe eclampsia,” added Margaret Mbowe of the maternity unit at the hospital.

Alisa Cameron, the USAID Health Team Leader, applauded the hospital for its efforts in reducing the percentage of deliveries that resulted in obstetric complications.

Mwale also applauded Jhpiego, and its work through the ACCESS and MCHIP Programs, for the technical support to the Ministry of Health, and expressed appreciation for USAID’s financial support.

While touring the hospital, the Secretary of Health, Chris Kang’ombe, was amazed at the facility’s cleanliness and beauty: “You are not only providing quality reproductive health services, your environment contributes to healing and patient satisfaction. Walking through the hospital grounds feels like being in a park in Europe, you even forget that you are at a hospital; well done and keep it up.”

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