Proud Mother and Baby in Rumphi, Malawi - photo courtesy of Jhpiego

When a review of reproductive health services at Mzuzu Central Hospital in Malawi found less than exemplary service, Director Rose Nyirenda was determined to resolve the challenges, improve patient care, and motivate her staff to achieve their personal and professional best. She and a quality improvement team organized an on-the-job training for all nurses, doctors and other clinicians to address the gaps in service.

The effort, carried out over 10 months and supported by USAID with technical assistance from the ACCESS and MCHIP programs, resulted in fewer maternal deaths and other significant improvements in patient care for women and newborns—and special recognition for the hospital as a Center for Excellence in Reproductive Health.

“You have made us proud, you are a role model hospital and we will encourage other hospitals to come and learn from your best practices and initiatives,” Deputy Minister of Health Theresa Mwale said at an awards ceremony held earlier this year.

The quality improvement program, part of a Ministry of Health initiative for government hospitals, focused on the quality of maternal health services in a dozen areas including management of normal and complicated labor and delivery, postnatal care of women and newborns, focused antenatal care (including malaria prevention, HIV counseling and testing, and syphilis screening) family planning, cervical cancer prevention services, and management of sexually transmitted infections.

As part of the program, a baseline assessment of hospital reproductive health services was conducted against which improvements would be measured. Three months after that assessment, Mzuzu Central Hospital conducted an internal review to check their progress. The hospital met the standards in 74% of the target areas, an increase from 50% at baseline.

Nyrienda and the hospital staff pressed on. In October 2009, a mere six months after the baseline assessment, the hospital achieved a score of 91%. The hospital’s performance drew the attention of the Ministry of Health (MoH), and in December 2009, a MoH team arrived in Mzuzu to conduct an independent review of the hospital’s 12 maternal health service areas.

The results – compliance on 89% of the standards – qualified Mzuzu as a Center of  Excellence in Reproductive Health service delivery. In a ceremony earlier this year, Director Nyirenda was presented with the prestigious shield of excellence in recognition of the hospital’s success in achieving best practices in the delivery of quality maternal health care.

“We are the first central hospital to be recognized as a Center of Excellence in Reproductive Health,” Nyirenda said at the award ceremony attended by the deputy Minister of Health and other dignitaries. “We are also the first hospital to be recognized following implementation of Performance and Quality Improvement using the Standards-Based Management and Recognition (SBM-R) approach in a record 12 months.”

The successes achieved by Mzuzu’s staff and facilitated through Jhpiego’s SBM-R approach had a direct impact on saving women’s lives. Maternal deaths from direct causes at the hospital fell from 2.5% in 2004 to 1.6% in 2009. There were improvements in early diagnosis and correct management of eclampsia and postpartum hemorrhage (PPH). “All our patients recovered fully, including those with severe eclampsia,” added Margaret Mbowe, of the maternity unit at Mzuzu hospital.

Alisa Cameron, the USAID health team leader, applauded the hospital for a record low level of obstetric complications (a decrease from 61.9% in 2004 to 20.9% in 2009). Mwale, the deputy health minister, also applauded the technical support through the ACCESS and MCHIP programs, and USAID for its financial support.

While touring the hospital, Secretary of Health Chris Kang’ombe was amazed at the facility’s cleanliness and beauty: “You are not only providing quality reproductive health services, your environment contributes to healing and patient satisfaction. Walking through the hospital grounds feels like being in a park in Europe. You even forget that you are at a hospital. Well done and keep it up.”