The Ecuadorian Ministry of Health (MOH) is scaling up an innovative essential obstetric and newborn care (EONC) model piloted by the USAID-funded EONC Networks Project in Cotopaxi province. The project, which is managed by the Center for Human Services (CHS), designed and implemented the model in close alliance with the MOH, USAID, and national and provincial NGOs, providers, and users.
The model used improvement approaches to implement evidence-based maternal and newborn health (MNH) interventions, which yielded significant improvements in MNH services. As a result, the Ministry issued a national policy making the application of the EONC networks approach mandatory throughout the country's entire health care system. The Ministry also assigned a special budget to the scale-up to ensure sustainability. CHS is supporting scale-up planning and training efforts, as well as the development of the guidelines and tools needed to make the scale-up successful.
"Scale-up and sustainability are key outcomes that drive our work," said CHS President Barbara N. Turner, "The Ministry's nationwide expansion of the EONC networks model serves as a strong example of a proven quality improvement approach transitioning from a demonstration in the field to policy implementation and resource mobilization at the national level."
The scale-up is part of Ecuador's maternal and newborn mortality reduction efforts and contributes to the global "Commitment to Child Survival: A Promise Renewed" initiative to reduce deaths among children under 5 years old by 2035. The global health community has reduced child mortality by 70 percent over the past 50 years, yet more than 6 million children still die each year before reaching their 5th birthday. Most of these deaths are from preventable causes. A Promise Renewed partners, such as USAID, are working to end preventable child deaths using innovative approaches like the EONC networks model.
"I'm happy to see the Ministry of Health applying this model across the country," said Dr. Jorge Hermida, CHS's Regional Director for Programs in Latin America and the Caribbean. "It has the potential to save the lives of many mothers and newborns, giving them a chance to survive and thrive."
Working across all levels of care, the model focuses on strengthening links between the postnatal health care services provided in homes and communities and those provided through the formal health system. The model targeted the country's 21 most vulnerable and marginalized communities in Cotopaxi and used proven quality improvement methods, such as the collaborative improvement framework, to improve equitable coverage and quality of EONC services. One key component was making traditional birth attendants, community organizations, and other local agents an integral part of the EONC network. These "local experts" worked together to find locally appropriate, evidence-based solutions to rapidly improve service quality and efficiency in their communities.
Initial findings from a project evaluation conducted this past summer show that the model contributed to significant improvements in practices to improve the health of mothers and newborns. Quality of services improved nearly universally in project sites. For example, compliance with newborn care standards in facilities rose from 13% to 50%. Exclusive breastfeeding, a practice shown to be essential for good infant health and development, rose from 38% to 51%. Also, more mothers could name neonatal danger signs (from 75% to 97%). Many more women were prepared for birth (57% to 73%), and traditional birth attendants (who provide care for many home births) referred more women with complications to health care facilities (50% to 83%). The percentage of clients who expressed satisfaction with health care services rose from 65% to 98%. The evaluation also found that visits by trained health care providers within the first two days after birth (when babies are most vulnerable) increased dramatically, from 4% to 70%.
Preterm birth linked to increased mortality risk from infancy to adulthood