Only increasing access to and utilization of health care services is not sufficient for improving maternal and newborn health outcomes. The quality of care a woman receives during pregnancy, delivery and postpartum affects her health, the health of her child and the likelihood of availing healthcare in the future. Measuring quality is also a step toward improving it for the existing system. Globally proven methodologies in healthcare quality improvement such as Model for Improvement, Plan-Do-Check-Act or PDCA models and Learning Network Models in Maternal and Newborn Care have been adapted by MaMoni MNCSP to suit the local needs of the country. In September 2018, Manikganj was selected as the first Quality of Care (QoC) district by MaMoni MNCSP, where the focused interventions to improve quality are implemented through a Learning Network. During this initial phase of the Learning Network, focus has been primarily on improving the quality of antenatal care being delivered, and improving the use of the Partograph (a graphic record of the progress of labour and relevant details of the mother and fetus) as a decision making tool. After the successful implementation in Manikganj, the team plans to expand the network in other MaMoni districts.
Innovations in healthcare system are needed to face the unprecedented challenges to improve quality, reduce harm, improve access, increase efficiency, eliminate waste, and lower costs. Innovative approaches to maternal and newborn care can make birth safer, save lives and ensure healthy living of babies. To address the challenge of slower improvement in newborn mortality, the MaMoni MNCSP supports the National Newborn Health Program (NNHP) of the Government. This includes interventions for the management of small and sick newborns, such as Kangaroo Mother Care (KMC). In the second year of the project, a National Newborn Health Program (NNHP) Cell has been established in DGHS to coordinate all newborn health interventions. Working in line with the public level interventions, MaMoni MNCSP has already reached a major district-level milestone in strengthening newborn care interventions, such as Essential Newborn Care (ENC), Helping Babies Breathe (HBB), Usage of Chlorhexidine (CHX) for umbilical cord care, KMC, supporting SCANU in health facilities, establishing fistula screening and referral at all levels and initiating alternative service delivery strategies in hard-to-reach areas.
Overall data management of maternal and newborn health from the field helps to generate a complete picture of the challenges in healthcare, actions that need to be implemented and the impact of the measures taken. MaMoni MNCSP utilizes innovation in its expansion and use of paperless electronic Management Information Systems in public health systems for proper data management.
The project supports the implementation of ICT-based innovations in health information systems and data use with the help of government’s HMIS system. It works on scale-up of facility eMIS in 10 priority districts, and also on strengthening national MIS data quality and use by health facilities and management. The eMIS system is designed to replace paper-based data management with digital form with fast and efficient e-registration, serves the purpose of monitoring from a central level, and ensures sustainability. Moreover, immediate notifications for emergency situations by the ICT-based innovations are helpful in management of emergency preventable causes like Pre-eclampsia. The profile-specific data recorded through eMIS system delivers text notifications for service recipients, under the text-reminder innovation of mHealth. OpenMRS, the hospital automation system supported by DGHS functions as the digital link between eMIS and secondary/tertiary facilities and ensures continuum of care. MaMoni has also developed FP-DHIS2, an open source District Health Information System (version 2) to transform the manual service statistics of Directorate General of Family Planning (DGFP) into a paperless system, HRIS for immediate resource mobilization, as well as the proper monitoring and management of government resources through Physical Asset Management.
With support from the project,the Family Planning department of Madhabpur upazila under Habiganj district is running a 100% paperless data management system in all of its 13 union level facilities. mHealth, which is an Information and Communications Technology (ICT)-based maternal healthcare reminder service, has also been tested successfully in a district and is ready to implement. The project also plans to implement an ICT-based client feedback mechanism to incorporate faster and efficient feedback from clients, and a transport referral system for recipients in hard-to-reach areas who need transport to avail services on an immediate basis, since lack of transport has been reported as one of the significant causes leading to maternal death. These integrated innovative approaches aid in facility readiness and create awareness, and offer sustainable solutions to reducing maternal and newborn death.