Project Name:
Quality Maternal and Neonatal Health Care
Project Location:
Cayambe Canton, Pichincha Province, Ecuador
Project Duration:
August 2011 – May 2012
CARE Contact:
Jorge Bejarano, Project Coordinator
Introduction
Ecuador, within the framework of the National Plan for Good Living (2009-2013), proposed a
35% reduction in maternal and neonatal mortality, a 25% reduction in teenage pregnancies, and
an increase of 70% in the coverage of childbirths in public health care institutions, by
implementing the National Accelerated Reduction in Maternal and Neonatal Mortality Plan, and
the National Teenage Pregnancy Prevention Plan.
In order to achieve these goals, the proposed strategies include the operation of a network of
obstetric and neonatal care, continuous quality improvement and the active participation of the
community.
CARE Ecuador, taking into account the Millennium Development Goals, Ecuador’s National
Plan for Good Living and its Strategic Plan, has been implementing since 2010 a Maternal and
Neonatal Health Program, with innovative, sustainable and proven models which contribute to
reducing maternal and neonatal mortality by: a) strengthening health care services with an
intercultural approach; b) citizen, community and social empowerment with gender equity; and
c) policy advocacy with decision makers to promote health rights.
One of these models (from the Building Blocks of Healthy Mortality project) was implemented
from July 2010 to July 2011, under the leadership of the Ministry of Public Health, with
technical assistance from the Provincial Department of Health of Pichincha and CARE Ecuador,
and with financing from the TOSA Foundation and Eduardo Castro Wright, in order to
contribute to the National Accelerated Reduction in Maternal and Neonatal Mortality Plan. This
project revealed the need to strengthen institutional and community capacities related to the
quality of care.
In this sense, from August 2011 to may 2012, with funding from Eduardo Castro Wright, CARE
Ecuador carried out a project entitled “Improving the Quality of Maternal and Neonatal Health
Care” in the canton of Cayambe (Pichincha Province), the main specific objectives of which
were: 1) To organize a network of obstetric and neonatal care within the health services of the
Ministry of Public Health; and 2) To implement a plan for the continuous quality improvements
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within the health care centers and the canton hospital of
Cayambe, with an emphasis on cultural appropriateness.
This report presents the results achieved from August 2011
to May 2012 through this project.
Activities and results project
During this period, the project activities focused on:
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Organizing and starting up a Network of Essential Obstetric and Neonatal Care.
Training in maternal and neonatal care, with a focus on human rights and interculturalism.
Implementing Childbirth and Obstetric and Neonatal Emergency Plans.
Implementing an outreach / educational campaign in maternal health.
Organizing and implementing a continuous quality improvement program in the area of
maternal and neonatal health.
The implementation of these activities contributed to the following results:

50 representatives from the community (presidents of cabildos and Parish Boards) and health
care institutions (the 8 health centers and the Cayambe cantonal hospital) were made aware
of the importance of organizing a network of obstetric and neonatal care to reduce maternal
and neonatal deaths and to improve the quality of care.

A Network of Obstetric and Neonatal Care for Health Area1 No. 12 of Cayambe of the
Ministry of Health is organized and functioning by levels of care; in which there is
complementarity between conventional medicine (doctors, obstetricians, nurses) and
traditional ancestral medicine (traditional midwives.

Organization of the system of referral and counter-referral between the health centers and the
canton hospital, as a result of the internship in the referral and counterreferal system of
Health Area No. 3 La Troncal (Cañar Province).

A referral and counter-referral system between the community and health care centers –
hospital in place, in which traditional midwives refer women for prenatal attention,
intercultural childbirths (in Cayambe Hospital), postpartum care, newborn attention and in
the event of obstetric and neonatal emergencies, using forms prepared by the project and
approved by the Ministry of Health.

42 traditional midwives from Cayambe have been trained and are applying their knowledge
in: a) the six cleans (clean place, thread for a clean umbilical cord, clean scissors, clean
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The Health Area is a technical administration/management unit of the Ministry of Health comprised of a Basic
Hospital and satellite health centers.
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hands and fingernails, clean bedclothes for
delivery, clean clothes for the woman and
the newborn) for home deliveries; b)
hospital cleaning for delivery; c) postpartum
and newborn danger signs; c) counseling on
exclusive breastfeeding.

30 midwives from Coca (Orellana Province)
have been trained in identifying maternal
danger signs, preparing childbirth and
family emergency plans, and maternal
breastfeeding.

31 health care professionals (general physicians and specialists, obstetricians, nurses) trained
in maternal and neonatal care with an intercultural approach.

16 doctors from Health Area No. 12 of Cayambe trained and
with the skills to apply the World Health Organization strategy
entitled “Helping Babies Breathe: the Golden Minute, which
will help reduce neonatal deaths from asphyxia upon birth.

20 nurses from the Cayambe hospital have been trained and are
applying that training in prenatal stimulation and
psychoprophylaxis for childbirth to improve the quality of
maternal and neonatal care.

1460 pregnant women received prenatal care and have
developed childbirth / family emergency plans, as a result of
the institutional strengthening efforts to impove the quality of care.

631 births were attended to in the Cayambe hospital with an intercultural and human rights
approach, which guarantees women the exercise of their rights to choose the position in
which they want to give birth, allows a family member to accompany them in the delivery
room and respects their customs and traditions.

Zero maternal and neonatal deaths
among women and children who received
timely care during delivery at the Cayambe
hospital.

9
representatives
from
the
leadership teams of the Health Areas of
Cayambe and Otavalo, and from the
National Office of Interculturalism,
participated in an international course on
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health care quality and international accreditation.

Nine health centers (1 urban center and 8 rural centers) and the canton hospital of Cayambe
are implementing the Improving the Quality of Care Program using rapid cycles (a method
which introduces concrete changes in health care processes through rapid cycles, using the
Deming cycle), as a result of CARE’s technical assistance and accompaniment from the
Ministry of Public Health.

Family members and women are satisfied with the quality of care during delivery and the
respect for their rights to choose their position during delivery and have a family member
accompany them.
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36 women community leaders from the Cayambe canton with raised awareness and
knowledge about leadership, empowerment, and sexual and reproductive rights.
One husband’s testimony: “This is the first time that
I have been able to be in the delivery room when my
child is born, this is my sixth daughter, I supported my
wife who decided to give birth sitting down. I placed
myself behind her to hold her and give her strength,
when I saw my daughter coming out, I wanted to
shout, I didn’t miss anything, I am happy”

A Strategy for Leadership and
Empowerment in Sexual and Reproductive
Rights has been developed in workshops with
women leaders.
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The Leadership Team of Health Area No.
12 has been trained in education/outreach. As a
result of this effort, currently the Health Area has
a social communicator, who is developing a
communications plan and informational brochures prepared with CARE technical assistance,
and financed by this project, on psychoprophylaxis and culturally appropriate childbirth.
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The culturally appropriate childbirth model has been documented and published in Spanish
and English, and disseminated locally, nationally and internationally.

Design, reproduction and distribution of the guide: sexuality in adolescence, a right with
responsibilities.
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The National Health Council is providing technical assistance to a consultancy on “Technical
and legal proposal to strengthen sexual and reproductive rights within the new legal
frameworks which contribute to the achievement of maternal mortality reduction targets in
Ecuador.”
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Replication of the strategy of childbirth and family emergency plans in the Otavalo canton of
Imbabura Province, and throughout the province of Pichincha, which will benefit 52,879
pregnant women.

Replication of the model of emergency obstetric and neonatal care in three communities in
the parish of Selva Alegre in Otavalo canton, with financing from multinational company
LAFARGE.
Conclusion

With the financial support from Eduardo Castro Wright, this project has strengthened the
institutional capacities of the Ministry of Public Health to: a) implement an obstetric and
neonatal care network, with a referral and counter-referral system by levels of care; b)
implement a quality improvement program, with standards and indicators which make it
possible to monitor the quality of care; c) apply childbirth and family emergency plans to
ensure culturally appropriate deliveries and attention in the case of obstetric or neonatal
emergencies; d) replicate the model in Otavalo (Imbabura province) to complement the
“Being a Woman in the Ecuadorian Andes” and the “Improving the quality of care” projects
being implemented in that canton; and e) demonstrating the Psychoprophylaxis and
Culturally Appropriate Childbirth Model as a proven, innovative model worthy of replication
at the national level
Next steps

To replicate the maternal and neonatal care model of Cayambe in the Pedro Moncayo canton
in Pichincha province, the Otavalo canton in Imbabura province and in the Quininde canton,
Esmeraldas province, with the implementation of the “Building Maternal and Neonatal
Health Care Capacities” project financed by Eduardo Castro Wright, which will start up in
July 2012.
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An eternal expression of gratitude from pregnant women, newborns, health care staff and the
communities of Cayambe.
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