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Improving Healthcare in Russia:
QAP Demonstration Models Help Reduce Maternal and Newborn Mortality

by Cynthia F. Young, Senior Staff Writer

Until recently, the leading cause of maternal mortality in the Tver region in Russia was pregnancy-induced hypertension. In the same region, respiratory distress syndrome was the single largest cause of early newborn deaths. Now, due to a unique partnership between the Russian Federation and the United States to improve healthcare in Russia, these causes aren’t No. 1 any more.

A working meeting of the Tula Oblast Hypertension Quality Improvement Team. (Left to right). Dr. Alefitina Pavlovna, Chief Cardiologist of Tula Oblast, Dr. Olimpiada Ivanovna, a general practitioner in Tula, Dr. Victor Melnikov, Dr. M. Rashad Massoud, and Vera Petrovna, QA Project Coordinator in Tula.


Working together with the Russian Federation’s Ministry of Health and local health departments, the USAID-funded Quality Assurance Project (QAP) and the Agency for Health Research and Quality joined efforts to improve the quality of healthcare in the areas of primary care and maternal and child health last year. This cooperation took place as part of the U.S.-Russia Health Committee, established under the U.S.-Russia Joint Commission on Economic and Technological Cooperation.

Quality assurance experts Dr. M. Rashad Massoud, QA Project Associate Director for Europe, Asia, and the Near East, and Dr. Anna Korotkova, Chief of the Methodological Center for Quality Management in the Russian Ministry of Health’s Central Public Health Research Institute, led the two pilot programs. Dr. Massoud and Ms. Hany Abdallah, MA, MHS, QAP Quality Assurance Specialist, described the program’s accomplishments recently at a presentation to the Agency for Health Research and Quality in Rockville, Md.

Dr. Massoud discusses improving maternal and neonatal care in Tver Oblast with participants at the Agency for Health Research and Quality.


Dr. Massoud explained that multidisciplinary teams, led by a steering committee of regional senior physicians and health leaders, addressed significant local health problems in the two regions of Tver and Tula Oblasts. (An oblast is an administrative region.) Choosing the specific health problems to address gave local health leaders a strong sense of project ownership - a crucial factor in the project’s success and subsequent expansion. "We felt if they worked together and tackled the issues that were important to them, they would be excited about the project and contribute to a higher effort later," Dr. Massoud said.

In Tver, the local team addressed two areas of Maternal and Child Health - to lower maternal mortality due to pregnancy-induced hypertension (PIH), and reduce newborn mortality due to respiratory distress syndrome (RDS). Mothers with PIH also tended to have a higher rate of newborns with RDS and infant mortality.

Maternity hospitals and emergency rooms also lacked adequate neonatal care. Here, RDS caused 66 percent of premature newborn deaths. QAP helped reverse this rate by redesigning the system of neonatal care at five facilities. A central referral unit, a neonatal intensive care center, was set up at a children’s hospital in Tver city. A neonatal ambulance system was created to transport babies to the center, and training was conducted to resuscitate, stabilize, and transport infants to the central unit.

The results of this pilot project were extraordinary. The newborn survival rate after resuscitation soared to 93 percent, babies transported to the center with normal body temperature rose by 46 percent, and neonatal mortality was reduced by 63 percent. These neonatal care services are currently being expanded to all 47 hospitals in Tver Oblast.

(Left to right) Dr. Victor Melnikov, Director of Health of Tula Oblast, Dr. M. Rashad Massoud, QA Project Associate Director for Europe, Asia, and the Near East, and Dr. Anna Korotkova, Chief, Methodological Center for Quality Management, Central Public Health Research Institute, Russian Federation.


A before-and-after study, done at two of the project hospitals using all PIH patients six months before and after the intervention, showed a substantial decrease in the cost of maternal care as a result of the new guidelines, said Ms. Abdallah. "Overall, there was an 87 percent savings in the average total cost of care," she said. "This was driven by a reduction in the number of hospitalizations, reduced lengths of stay, and a decrease in drug costs and average cost of care per patient." It illustrated that improved quality can be accomplished at reduced costs.


In Tula Oblast, where cardiovascular disease was the leading cause of adult mortality, the team decided to strengthen the system of primary care to reduce arterial hypertension.

Here in this industrial region hypertension was high, affecting an estimated 27 percent of the adult population. Here, the system of hypertension care was improved in six demonstration clinics by changing the process of hypertension care delivery, screening the population at risk to identify and treat patients with hypertension, and promoting healthy lifestyles through diet, exercise and reducing smoking.

The results included a three-fold increase in patients managed at the primary care level. This was mainly due to seeing an increase in patients with first-degree hypertension, in whom hypertension can often be controlled without the use of drugs. Blood pressure control was achieved in 83 percent of patients followed in the six clinics. Hospitalization for hypertension decreased by a dramatic 93 percent, and importantly, hypertensive crises dropped by 57 percent. Due to this success, this improved system of hypertension care is currently being expanded to 131 general practitioner clinics throughout the region.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.