Reducing infant and maternal mortality : The experience of Belo Horizonte city, Brazil

The Perinatal Committee, structured in 1994 at the Belo Horizonte (the third capital of the country) Health Department is an interinstitucional board - also aggregating the social movement - that functions in order to qualify perinatal health care, decrease maternal, infant and perinatal mortality rates in the city. Regionalization and hierarchization of the perinatal health system increased access to pregnant women to prenatal care through a central regulatory system, promoting equity. A continuum of care from the prenatal facility to a maternity hospital guarantees access for women to immediate admission when in labor. There was an 80% increase in neonatal intensive care units and significant investments in health professionals’ education. Monitoring maternity hospitals is in course since 1999 and was determinant to the decision of closing 6 low quality care facilities. Medical auditors observe the health care process in loco in a fundamental initiative to maintain the quality achieved, as well as the participation of community members assessing the health care giving process. Humanization of care is an enduring effort to decrease the high levels of cesarean-section, almost 90% in the private hospitals. Other initiatives are volunteer doulas in all public maternity hospitals and training of multipliers and health counselors in children’s and women’s rights to health. Surveillance of all maternal, fetal and infant deaths is done to access health care practices and subsidize measures to prevent new events. In 2007 was launched the movement BH for Normal Birth gathering 30 public and private institutions, universities, professional and social organizations. A significant decrease in infant mortality (22//1000 in 1999 to 11.7 in 2007) - especially in the early neonatal period - and maternal mortality (66 to 42.7/100.000) was achieved. This experience of public health management providing quality in prenatal and hospital care can be expanded to the whole country.