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LAMM Yapacani Hospital Ranked Fourth in Bolivia
by Cynthia F. Young, Senior Staff Writer



Yapacani Hospital Photo by Karen Askov

The Bolivian Ministry of Health recently ranked Yapacani Hospital as the country’s fourth best hospital in its year 2000 study, a notable recognition of the hospital’s efforts to improve the quality of maternal care by reducing maternal mortality. The recognition also is remarkable taking into account that the QA Project’s initiative to improve the quality of care began less than a year ago.

The hospital is one of four facilities in the Ichilo district in the department of Santa Cruz and is part of the U.S. Agency for International Development’s Latin America Maternal Mortality (LAMM) Initiative. The QA Project has been providing technical assistance in quality improvement to Yapacani Hospital since early 2000.

"This recognition is a result of the extraordinary performance, dedication, and enthusiasm of the doctors, nurses, technicians, and administrators at Yapacani Hospital to improve the quality of maternal care," said Stephane Legros, MD, MPH, Senior QA Advisor and Deputy Director, LAMM Initiative. "To receive this designation after less than a year of working together is an example of their excellent skills and teamwork in problem solving and developing effective solutions."

Yapacani Hospital, a second- level hospital, was ranked fourth overall in a study managed by the Ministry of Health involving the country’s 250 health facilities at the second- and third-levels of care. Second-level hospitals have physicians and nurses available to attend patients 24 hours a day and have the necessary equipment and supplies. A third-level hospital has specialists for patients who are referred from the primary and secondary levels of care. Of 2,500 health facilities in Bolivia, 90 percent are designated first level, 8 percent are second, and 2 percent are third level. The facilities were ranked for their compliance with basic standards, perinatal attention standards, client satisfaction, and institutional coverage.

Under the direction of LAMM Coordinator, Lic. Rosmery Chavez, RN, MPH, the project has made extraordinary strides to improve access to and the quality of essential obstetrical care (EOC) in the district, particularly in clinical skills training, quality improvement, quality monitoring, and improved ability of community members to recognize danger signs during the pre-natal, pregnancy, and post-partum periods.

The LAMM Initiative, which began in 1997, is a collaboration between the QA Project and the Pan American Health Organization (PAHO) to promote and formulate policy to reduce maternal mortality in 11 Latin American countries. The QA Project works in three: Bolivia, Honduras, and Ecuador, to strengthen linkages between communities and health services, increase access to maternal health services, and improve the quality of essential obstetrical care. The QA Project has been providing technical assistance to four facilities in Ichilo since 1999 and has reached more than 60 communities.

Lic. Chavez established a clinical skills training program and created a training center for obstetrics/gynecology physicians in Montero Hospital, Ichilo’s referral-level facility. Through this training program, 100 percent of Ichilo’s health care providers (pediatricians, obstetricians and gynecologists, general physicians, nurses, and auxiliary nurses) have successfully completed competency-based EOC clinical skills training.

She also worked with Ichilo healthcare facilities to form quality improvement teams in each hospital to learn quality improvement methodology, develop standards for obstetrical care, measure indicators for each standard, and implement interventions to improve pre-natal and delivery care. These multi-disciplinary teams, which include physicians, nurses, auxiliary nurses, laboratory technicians, and administrators, work to improve key processes for pre-natal care and attention during labor and delivery.

Some of the interventions developed by the quality improvement teams were so successful that they are now being implemented throughout the district, including the standardization of monitoring for potentially life-threatening post-partum complications. (posted June 29, 2001)

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