Improving emergency obstetric care in Mozambique: the story of Sofala.
OBJECTIVE
The 5-year project in the province of Sofala was designed to improve access, quality and utilization of emergency obstetric care (EmOC) by strengthening rural hospitals and health centers and ultimately the health system's capacity to respond to emergencies more quickly and effectively.


METHODS
Implementation consisted of attention to infrastructure, human resource development, transportation and communication systems, and management. Specific management aspects that were targeted for improvement included: supportive supervision, logistics for supplies, equipment and drugs, record keeping, monitoring and evaluation, and quality improvement techniques such as maternal death audits.


RESULTS
Access to EmOC improved with an increase in the number of fully functional EmOC facilities from 4 to 18. The number of women with obstetric complications who were admitted for treatment in participating facilities tripled, and the proportion of those women dying declined by half.


CONCLUSIONS
Close collaboration and partnership with the provincial health directorate make the sustainability of many results likely while the replication of much of the Sofala model to other provinces is promising for the national strategy to reduce maternal mortality.
Santos
C
C
International Center for AIDS Care and Treatment Program, Maputo, Mozambique.
Diante
D
D
Baptista
A
A
Matediane
E
E
Bique
C
C
Bailey
P
P
D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D009073:Mozambique; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control*; D009774:Obstetrics / Q000193:education; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000592:standards; D011247:Pregnancy; D015397:Program Evaluation; D012041:Regional Medical Programs; D017749:Total Quality Management / Q000379:methods*