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Conferences Conclude LAMM Initiative in Bolivia, Ecuador, and Honduras
by Cynthia F. Young, Senior Staff Writer

Three closure conferences were held recently in Bolivia, Ecuador, and Honduras to mark the completion of the QA Project’s work in support of the U.S. Agency for International Development’s (USAID) Latin American Maternal Mortality Initiative (LAMM) Initiative. The QA Project has been providing technical assistance in these countries since 1997. 

LAMM logo

USAID created the LAMM Initiative to strengthen the quality of essential obstetric care (EOC)  in 11 Latin American and Caribbean countries and to reduce maternal mortality in this region where a woman is 27 times more likely to die during pregnancy than a woman born in the United States. The Initiative team consisted of the QA Project, the Pan American Health Organization (PAHO), CEPAC, and Plan International.

As part of the Initiative, the QA Project strengthened a broad array of interventions to improve the quality of care. They included on-the job training programs linked to communication of standards, data collection, and involvement of health care providers through problem solving and (re)design teams. 

The partnership took a threefold approach to reducing maternal mortality, including building advocacy to reduce maternal mortality through policy, improving the quality of EOC services, and promoting information, education, and communication to mobilize communities to access health services.

Now that the technical assistance portion is concluded, the Initiative will continue to build on these achievements, ensuring that momentum is sustained at the community, facility, and government levels. PAHO will wrap-up and systemize Initiative activities and findings, promote government policies to sustain the interventions in place, replicate these models in other areas, and expand to other Latin American countries. 

Ecuador.  In Ecuador, the closing conference was held in September in Latacunga, the capital of Cotopaxi province, where the activities took place. The Initiative, which was implemented in two hospitals, a health center, and 50 communities, is part of a countrywide health sector reform.

A patient preparation room at the health center in Ecuador remodeled to give patients more room and  privacy.

Posters depicting project work on the community and institutional levels were displayed. Participants described the processes and their teams’ results. Attendees included representatives from the Ministry of Health (MOH), the National Project Committee, Ecuadorian Institute of Social Security, the QA Project, and Plan International.

Dr. Teresa Brazales, Director of Health Education in Cotopaxi province, and Dr. Carmen Laspina, National Director for the Ministry of Health’s Promotion and Integration of Health Care, discussed the importance of lowering maternal mortality and the project’s activities.

Dr. Jorge Hermida, Associate QA Project Director for Latin America, and Dr. Luis Vaca, LAMM Field Coordinator, described how the Initiative helped reduce maternal mortality, and Dr. Fernando Mejía, Director of Health for Cotopaxi province, presented the results of the project’s initiatives. 

The QA Project’s LAMM activities in Ecuador included:

The implementation of activities by Quality Design teams to manage obstetrical complications, neonatal care, and labor monitoring. For example, in Latacunga hospital, teams created a first-floor emergency delivery room, because sometimes women who were about to deliver could not to reach the second-floor obstetrical ward quickly enough. As a result, 53 women delivered their newborns in this room.

Workshops trained more than 250 participants in clinical training of EOC and management of obstetrical and neonatal emergencies, practical clinical skills training, and clinical skills monitoring. Rapid surveys were conducted in healthcare facilities and communities, and rated all facilities an “A.” A provincial Network of EOC Providers was formed, the use of forms were standardized across EOC network institutions, instruments were developed to improve the management of drugs and supply stocks, and reproductive health standards based on clinical case studies were disseminated.

Quantitative results included the percentage of met need for obstetrical complications in Cotopaxi Referral Hospital increased from 25 percent in 1998 to 55 percent in 2000. The number of deliveries at Salcedo district hospital dramatically increased 180 percent over three years.

At the end of the closure conference, diplomas and certificates in Essential Obstetric Care, Dissemination of Reproductive Health Standards, and Birth Attendant Training were presented to trainers and participants. Project reports were also distributed to guests. 

Honduras. At the Honduras conference, which was held in Tegucigalpa in September, quality improvement teams and users’ committees presented the results of their activities and accomplishments. During the day-long event, one speaker noted that the Initiative was one not of “closure,” but of “beginning.

Speakers included Dr. Arturo Gutierrez, MOH Director of Health Services, and former Director of Health for the Comayagua Region, where the Initiative took place. Participants included the Minister of Health, representatives from USAID, PAHO, the IDB Reform Project, and community and institutional participants in the Initiative. In 2000, LAMM activities were expanded in Region 2, and quality assurance will continue to expand in Regions 2 and 5.

Bolivia. Since 1999, the QA Project has been providing technical assistance in Bolivia to four hospitals and a health center in Ichilo, Santa Cruz, reaching more than 60 communities. Quality Improvement teams were formed to analyze EOC services and develop and implement solutions.

The closure presentation took place in late January in La Paz, with 35 representatives of the MOH, the NGO community, PAHO, UNFPA, German cooperation, and USAID health team members in attendance. Presentations were made by Dr. Susan Brems, USAID’s Health Team Director, Dr. Roberto Kristovich of PAHO, Widen Abastoflor, Director of CEPAC, Lic. Rosmery Chavez, LAMM Coordinator, and Dr. Jorge Hermida.

The conference included presentations on the following:

  • LAMM project components and framework, including the Pathway to Perinatal Survival
  • Strategies and methodologies for the community and institutional components
  • A video of community activities that was developed by the QA Project and CEPAC
  • Results of the initiative, including essential obstetric care (EOC) indicators and compliance with EOC standards

Educational materials developed by the community also were displayed, including information on a radio soap opera performed in both Spanish and Quechua.

Dr. Susan Brems publicly congratulated the QA Project and CEPAC, saying that this was one example of a project that has achieved concrete results. For example, maternal deaths dropped dramatically in the area from 5 deaths in 1999 to 2 in 2000 and 1 in 2001. There have been similar drops in neonatal mortality. This project also gave importance to community work integrated with health facilities, and achieved an important level of participation from the local Ministry of Health.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.