Volante sobre los avances del proyecto HCI en la aplicación del Método Madre Canguro en cinco países de América Latina.

1. 1.  Analyze differences in the process and results between the demonstration and replication phases for the purpose of learning strengths and weaknesses of each phase to guide spread activities.
2. 2.    Document the level of QI institutionalization and/or activities maintained upon finalization of the implementation phase to determine what needs to be strengthened.
3. 3.     Document the changes implemented that have been successful in achieving improvements in EONC care for the purpose of spreading these effective changes to other regions.

In 2008, the USAID Health Care Improvement Project (HCI) took on the challenge of improving the learning system for health care improvement. This learning system includes the processes of harvesting, analyzing, and synthesizing knowledge about what teams do to improve health care and the process of sharing what they learn with other QI teams. Using experience to date and some innovations, HCI developed a set of four tools—collectively known as the “Standard Evaluation System” (SES) tools—for teams and their coaches to use to facilitate these knowledge management processes. The SES tools include a QI team-level Journal, a QI team-level Synthesis Form, and two databases for results indicator data—one for QI teams and the other for the collaborative level. These tools were created to help support the collaborative learning system by which teams examine which of their changes were most effective and sharing this learning with other teams in the collaborative. This report summarizes the results of testing these SES tools to strengthen documentation, analysis, and sharing of QI team efforts to improve care through testing of changes.

In an attempt to address high maternal mortality and morbidity in Latin America and the Caribbean, the United States Agency for International Development (USAID) began the Latin America and Caribbean Regional Initiative to Reduce Maternal Mortality (LAMM) in 1996. Recognizing that existing USAID-supported programs already address family planning, prenatal care, and clean delivery strategies to reduce maternal mortality, LAMM targets essential obstetric care at the first level of referral facilities. Bolivia, Ecuador, and Honduras were sites for the development and pilot testing of essential obstetric care (EOC) interventions. Under LAMM, the Quality Assurance Project (QAP) is responsible for supporting process redesign and quality improvement teams as they address weak components in the EOC system. QAP conducted a baseline assessment of the quality of care and compliance with EOC standards at the facility level in a selected area of each country in 1998. The QAP LAMM team developed a set of 21 indicators to measure quality of care and how each system was functioning. Data on the indicators were collected through the review of patient medical records and other facility records, structured observation of deliveries, and a questionnaire completed by healthcare professionals. The assessments indicate that adequate infrastructure to provide EOC exists in all three study areas. However, deficits were documented in the capacity of these facilities to deliver quality EOC services. Inadequate supplies and equipment, lack of trained personnel, and failure to comply with quality standards all limit the functional access to EOC. The assessments also suggest that low utilization of the study facilities is an important barrier to the delivery of EOC in all three countries. Over a third of the staff surveyed reported never having been trained in the management of obstetrical emergencies. With respect to the performance of clinical EOC tasks, the assessments found that time intervals between recordings of fetal heart rate failed to meet international standards. Asepsis was routinely practiced during delivery in all three countries, while the administration of hemoglobin tests to patients whose admitting diagnosis suggested the possibility of hemorrhage varied widely among the three countries. The assessments also examined whether basic tasks were recorded in patients' medical records, and many tasks appeared unrecorded. The assessment results suggest that a variety of interventions will be required to increase awareness of and compliance with performance standards. Such interventions could include effectively disseminating and communicating standards, in-service training, job aids, increased supervision and monitoring, and assuring availability of supplies and equipment through process redesign and quality improvement. The LAMM initiative contemplates repeating assessments in 2001 to evaluate the effectiveness of its efforts. The adequacy of the 21 indicators to reliably measure the initiative's achievements should be reviewed, and efforts should be made to better standardize data collection instruments and sampling methods. Some of the original indicators may be hard to interpret as gauges of progress, and there may be other indicators that should be introduced. A new set of nine indicators, including five of the original ones, has been introduced by LAMM for routine quality monitoring. These indicators should be considered for future facility assessments. (excerpt)