Improving quality for baby starts with the mother

Hospitals in Malawi continue to struggle with inadequate resources – staffing, space, and equipment – and the quality of care mothers and newborns receive suffers. Yet through trainings, ongoing mentorship and strategic planning, improvements are taking place at the Ntcheu District Hospital. The Maternity Ward Patron, Bema Mkatumula, said that previously,  “to follow up a [pregnant] woman wasn’t easy because of the congestion and lack of resources. We have had a lot of issues because there was no accountability in the care that was given and a lot of complications were missed.”

Recognizing the link between maternal and newborn health and the existing gaps in quality care, the District Health Management Team at Ntcheu District Hospital strategized innovative approaches to improve service delivery in the labor ward. One strategy applied was to allocate specific staff to specific beds. “Now every day nurses are allocated to one or two beds in the ward,” said Madalisto Mwanlina, the nurse ward in charge. “Those nurses know that everything that happens in that bed is their responsibility from the woman’s admission to her discharge to postnatal. It helps to make sure all patients are monitored regularly and that nothing is forgotten.”

The team also established a runner and a team leader in the labor and delivery ward. A runner is responsible for resupplying resources and updating the emergency trays while the team leader is responsible for ensuring patients are properly monitored, documented and supported with and that support/expertise is provided as needed. “By allocating a different runner and team leader every day, the hospital is empowering people to take ownership, be accountable, and gain leadership skills,” said Gedesi Banda, Save the Children Project Manager for Saving Newborn Lives.

Guidelines for these positions and the ward protocols are posted proudly on the wall. “After a year, we are on track and things have started improving. Now we are even trying to take similar protocols to other wards,” Bema Mkatumula.

During morning handover in the Ntcheu Maternity Ward, nurses discuss roles and responsibilities for the day.

In February 2017, Malawi hosted the global launch of the WHO Network for Improving Quality of Care for Maternal, Newborn and Child Health with a commitment to cut preventable maternal and newborn illness and deaths, and to improve every mother’s experience of care. As Malawi moves forward with this agenda of quality improvement, we must look to examples like Ntcheu District Hospital and remember how closely newborn health and survival and stillbirth prevention are linked with the care a mother receives.

Saving maternal and newborn lives is a critical and ongoing effort. We must invest in mother and newborns together at all levels with commitment from local leaders, civil society and professional organizations. Only then will Malawi achieve the ambitious goals set out in the Quality of Care Network.

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