HEALTH CARE IMPROVEMENTPROJECT

Rosa Delmy Fuentes Hernández, 22 years of age, resides in the town of La Paz, located in the Bolivar

municipality of La Union in El Salvador. Rosa is a multiparous woman who was admitted to the Santa Rosa de Lima National Hospital in La Union in active labor, with a full-term pregnancy. Following a normal delivery, she gave birth to a girl weighing 7.28 lbs with Apgar scores of 8 (one minute) and 9 (five minutes).

Rosa recalled the hospital obstetric care team’s efforts to put her baby to her breast immediately following birth, an evidence-based practice that has been shown to facilitate successful breastfeeding.

“They placed the girl in my arms on my chest right after she was born. The nurse helped me breastfeed the baby immediately after delivery. From that point on, I have breastfed her as much as I can,” said Rosa.

She also recalled how the hospital team was concerned with ensuring she was able to breastfeed her baby on demand. “After they cleaned my baby following the birth, they brought her to the room and left her with me the whole time so I could breastfeed her as much as she wanted.”

This story is what Santa Rosa de Lima Hospital aspires to do with every delivery: a healthy mother and baby pair who are well on their way to successful breastfeeding. This positive outcome has been facilitated by the Ministry of Health’s national initiative to continuously improve the quality of health services through evidence-based standards and data-guided improvement activities, a

program supported by the American people through the United States Agency for International Development (USAID).

A HEALTH CARE IMPROVEMENT SUCCESS STORY

REACHING MATERNAL AND NEWBORN CARE STANDARDS IN SANTA ROSA DE LIMA HOSPITAL

Delmy Fuentes nurses her newborn daughter. Santa Rosa Hospital’s support for immediate breastfeeding following delivery, breastfeeding counselling, and rooming in facilitate infant feeding success stories like this one. Photo by Domy de Herrera, URC-El Salvador.

SEPTEMBER 2010

The work of the USAID Health Care Improvement Project (HCI) in El Salvador is supported by the American people through the United States Agency for International Development (USAID). HCI’s work in El Salvador is managed by University Research Co., LLC (URC) under the terms of Contract Number GHN-I-02-07-00003-00. For more information on the work of HCI, please contact hci-info@urc-chs.com or visit www.hciproject.org

Alba Luz Sayas, Social Worker at Santa Rosa de Lima Hospital, visits newly delivered women to provide counselling on newborn care and exclusive breastfeeding. Photo by Trinidad Granados, URC-El Salvador.

Now implemented in all 28 maternity hospitals of El Salvador’s national health system, the continuous quality improvement program, coordinated by the Ministry of Health’s National Quality Committee, first established 21 key health care delivery standards related to obstetric and neonatal care, family planning, and prevention of infections. Then the program supported individual hospitals to institute a rigorous self-assessment process through the review of randomly selected records, to measure each hospital’s actual performance according to standards. The roll-out process for the continuous quality improvement approach involved a series of training workshops where local hospital committees came together to learn about quality improvement methods and to share their results and experiences in trying to improve care to achieve the standards. In this way, hospital teams have learned from each other how to strengthen critical care processes and improve patient outcomes.

In the post-partum recovery room at Santa Rosa de Lima Hospital, social worker Alba Luz Sayas contributes to the quality of care provided to new mothers such as Rosa Delmy by providing counseling on basic care of the newborn, including the importance of exclusive breastfeeding.

Given the overwhelming scientific evidence that exclusive breastfeeding in the first six months of life is associated with decreased infant morbidity and mortality, breastfeeding promotion is a critical part of essential obstetric and newborn care in the Ministry of Health system. Steps that hospitals should follow to facilitate exclusive breastfeeding are detailed in National Quality Standard 18, which addresses early breastfeeding (i.e., within 30 minutes of delivery), rooming in, and breastfeeding counseling.

In this brief story of how adherence to quality standards has become the routine in this hospital, we can observe how the Ministry of Health’s continuous quality improvement program is making a difference in outcomes for women and their newborns in El Salvador.

As Alba Luz Sayas noted, “quality improvement is practical since interventions are made quickly by our own personnel. In addition, we have seen that better compliance with the standards has enabled us to detect more quickly complications in the first two hours of the postpartum period, such as obstetric hemorrhage. This has improved outcomes for both mothers and newborns.”

To learn more about the Ministry of Health’s National Quality Improvement Initiatives, please contact. Dr. Francisco Vallejo F. at fvallejo@urc-chs.com.

USAID Health Care Improvement Project in El SalvadorCalle Circunvalación # 298, Colonia San Benito. • TEL 503-2501-1800 • FAX 503-2501-1888

University Research Co., LLC • 7200 Wisconsin Avenue • Bethesda, MD 20814-4811 • USA TEL 301-654-8338 • FAX 301-941-8427 • www.hciproject.org