The Dominican Republic’s Expanded Baby and Mothers Friendly Hospital Initiative: Achieving Reductions in Maternal and Neonatal Mortality

Presenter: Sarita Menendez, UNICEF

Background: Maternal mortality (MM) and neonatal mortality (NM) are high in the Dominican Republic (DR), at 109 per 100,000 live births and 25 per 1,000 live births respectively, although the universal coverage of prenatal care and institutional birth. Estimates suggest that 60% of MM and 80% of child deaths are preventable. In 2012, following the President’s declaration that MM and infant mortality reduction was a priority, UNICEF partnered with the Ministry of Health to expand BMFHI with 4 new components in addition to breastfeeding: quality antenatal care, clean delivery, infection prevention in newborn care and timely birth registration.

Methodology: Baseline data is collected for each BMFHI component for prioritized hospitals, their primary care services and communities. Next, in collaboration with health staff, key bottlenecks are identified, and an improvement plan is created, including designation of responsibilities. At all steps, local authorities provide oversight and involvement. Priority activities undertaken focus on changing health personnel routines, and training on breastfeeding, prenatal quality control, clean delivery, immediate newborn care, biosafety and birth registration and health promotion activities at communities.

Results: Three hospitals and their primary care centers and communities established baselines, improvement plans, are implementing activities relating to all components and they expect to be certified by this year as expanded BMFHI. In one of these hospitals, neonatal mortality due to sepsis decreased from 61% in 2012 to 18% in 2014, and the percentage of children registered at birth increased from 40% in 2012 to 72% in 2014.

Conclusions: Estimates by the local UNICEF office for the implementation of the Expanded BMFHI in 10 priority hospitals show that in the next three years 1,200 newborns can be saved, and that the Ministry of Health could save 33 million dollars in preventing complications and avoiding babies treated in intensive care unit.