Gaza Strip, 16 July 2012 – Ministry of Health childbirth professionals presented the results of an innovative programme introduced into two hospitals in the Gaza Strip, with the technical support of WHO, to improve quality of care for mothers and newborn infants. The programme promotes a midwifery-led approach for low-risk deliveries and improved early detection of complications during the perinatal period. After the programme’s successful implementation in Nasser Hospital in Khan Younis (900 deliveries per month) and Tel al Sultan Hospital in Rafah (600 deliveries per month), representing about 30% of all deliveries in the Gaza Strip, the Ministry of Health to decide to introduce the programme into all maternity units in the Gaza Strip, including those newly established.
Dr Walid Madi, Director of Hilal al-Emirati hospital in Tel al-Sultan, Rafah, who supported the new methods from the start, said the programme had relied on the data for evidence of success. “We are using more detailed data now to analyse our performance as a hospital, for example, by examining monthly rates for caesarian sections to understand trends and how to reduce the number of unnecessary operations,” explained Dr Madi. “I fully support the women and am interested in improving health outcomes.”
The important role of midwives has not been well understood in occupied Palestinian territory, but they are gradually being viewed with greater respect inside and outside the medical community as childbirth professionals. “We use a team approach,” added Dr Omer Bahnasawi, head of one of two main departments in Tel al-Sultan, “and we can trust our midwives to do more low-risk deliveries. Midwives manage about 30% of all deliveries but this could be expanded to half of all deliveries.”
Health policy-makers recognize that the medicalized system for childbirth care should be revised towards a modern, evidence-based and de-medicalized model of care that respects women’s rights and dignity. Change has been slow but results are now unequivocally positive, judging from the data in patients’ charts as well as from the attitudes of women and hospital staff.
The programme began with WHO recommendations that were adopted by the Ministry of Health and focused on an assessment of gaps in the quality and safety of hospital care for mothers and newborns that can increase the risk of deaths and complications. WHO’s lead medical consultant, Dr Silvia Pivetta, described the assessment as “strongly participatory” and involving “priority-setting and planning, with a strong bottom-up approach with hospital staff and managers.”
In the first two years, the programme supported extensive training, coaching and technical support for staff and managers in two Ministry of Health hospitals, and introduced a health information system for use during the perinatal period. Among the large number of professionals involved, several “agents of change” were identified and given space and support to nurture the approach.
In January 2011, the Ministry of Health, with the support of key professionals in the Gaza Strip (obstetricians, neonatologists and midwives) adopted the new model of midwifery-based care and early detection of complications for initial piloting in one hospital and further implementation in all maternity units in the Gaza Strip. The programme coincided with the Tel al-Sultan hospital’s need to train 10 new replacement midwives, which also provided a timely opportunity to upgrade midwife skills.
While medical professionals are typically cautious in attributing improved outcomes to specific interventions, the preliminary data are encouraging and suggests that in Nasser hospital, for example, stillbirth and very early neonatal death rates – one of the main indicators for intrapartum care – are decreasing.
The programme has been funded by AusAid and Norwac, with early funding from the Spanish Cooperation, but the extension of the programme to cover other Ministry of Health hospitals will require additional funds. WHO is looking for international donors to support the continuity of the programme.