QI Story: Enhancing Maternity Care at Matawale Urban Health Center, Malawi – A Solution to Manageable Maternal Referrals

Presented By:Mariaenzo Kumbanga, Nursing Officer, Matawale Urban Health Center, Malawi

Matawale Urban Health Centre’s Maternity Department faces a persistent challenge of an increasing number of maternal referrals with manageable conditions at the health center level, noted since September 2021 through monthly data analysis. This issue occurs regularly, with a baseline of 64%. The aim is to reduce the percentage of health center manageable maternal referrals from 64% to 30% between October 20, 2021, and December 31, 2021.

The outcome measure involves assessing the percentage of health center manageable maternal referrals, with the numerator being the number of such referrals and the denominator being the total number of pregnant women referred out.

A root cause analysis using the 5 Whys identified factors such as increased referrals, poor assessment, lack of confidence, and insufficient knowledge and skills.

To address these issues, changes were tested, including mentorship and supervision, CPD sessions on proper assessment of women in labor, and assessment before referral by the second on-call. Best practices include successfully reducing wrong referrals, establishing a clinic day for reviewing women at risk, training midwives for scanning, implementing comprehensive handovers, maintaining vibrant QIST and WIT, and ensuring service integration.

Achievements include effective teamwork, reduction in health center manageable maternal referrals, revision of admission forms, introduction of postpartum forms, participation in a documentary exercise, hosting benchmarking exercises, and developing tools for quality care implementation.

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