APPROACH AND METHODOLOGY
The SFCMH Initiative will be implemented in maternity hospitals using a procedure manual, with evidence-based axes, principles and interventions, as the basis. An assessment guide will also be used, and potentially modified according to the beliefs and cultures of each community. In case that a trans-cultural adaptation should be necessary, it will be planned and implemented with local staff and methodological specialists.
An SFCMH Champion will be identified in each of the targeted maternity hospital. This person will be a health professional, elected by local authorities to assist and monitor local implementation processes.
To support the activities within each maternity hospital, an interdisciplinary FUNLARGUÍA team will organize different types of workshops for the training and qualification of medical doctors, nurses, social workers, and other health agents, in the multiple steps of the initiative.
The following ten steps will be implemented by each hospital:
Step 1: Recognize Safe and Family Centered Maternity Hospital as an institutional policy.
Step 2: Provide support to the pregnant mother and her family during prenatal control.
Step 3: Respect the decisions made by the mother and her family during labor and delivery.
Step 4: If the child is healthy give priority to rooming in and family participation.
Step 5: Facilitate the inclusion of the mother, father and family during the newborn's hospitalization.
Step 6: The maternity hospital must have a residency for mothers to allow the permanent contact between them and their hospitalized newborns.
Step 7: The maternity must have a volunteering service.
Step 8: Discharge and mother child ambulatory follow up in specialized outpatient clinics that give priority to family inclusion.
Step 9: Take an active part in the promotion of breastfeeding in accordance with the guidelines of MBFH 'Mother and Baby Friendly Hospital'.
Step 10: Receive and provide cooperation from and to other institutions to become SFCMH.
Follow up of each local process will be made using an educational web platform (i.e. e-learning) with periodical reports and programmed exchange visits to/from the centers and Sardá Maternity Hospital by Funlarguía's team members and local champions. The number and professional profile of exchange visits will be tailored to the local processes needs guaranteeing not less than 1 or 2 visits to the local center and 2 to 3 visits from the local teams to the Sardá Maternity. Finally, according to evaluation, different strategies will be suggested in order to fulfill the objectives of the initiative.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
Funlarguía, the National Ministry of Health, UNICEF Argentina and other partners will aim to incorporate the initiative in 20 maternity hospitals per year, until January 2016.
September 2011 - March 2012: Funlarguía and partners will work with regional and institutional Directive Boards on the institutional policies and on the training of the designated local 'SFCMH Champions' - each maternity hospital will have a designated health professional elected by local authorities to assist and monitor local implementation processes.
March 2012 - January 2016: Each year, Funlarguía and partners will work with 20 hospitals to implement the initiative's activities. This will be organized primarily through workshops that are held by Funlarguía's team, with the assistance of local champions and other stakeholders.
Funlarguía is testing the e-platform as a 'beta' version with a select number of institutions. Currently and in the medium term, UNICEF Argentina is providing the web infrastructure and hosting. Funlarguía is, at this stage of the platform development, testing some basic tools and building the 'tutors team'. The 'final' version will be completed by November 2011.
More than 700,000 newborns are delivered every year and 60% of these births take place in public hospitals. While the institutionalization of childbirth has improved health results and reduced at home birth to almost zero, this change produced a new problem: maternity hospitals now do not guarantee humanizing care. This institutionalization has not been accompanied by the preservation of the rights of women and their families with respect to the birth of their children. The institutionalization of birth has resulted in a policy of 'Family Out,' restricted visiting hours, medicalization of delivery and interference in mother-infant bonding and attachment. The SFCMH will implement a 'Family In' policy in all areas of the hospital and empowerment for women and their families.
The SFCMH model has been developed and implemented by Dr. Miguel Larguia and members of Funlarguía in the Ramón Sardá (HMIRS) Maternity, in Buenos Aires, for the last 35 years. Initially, the SFCMH initiative incorporated different innovative and proven effective interventions. The theoretical basis of the initiative has been recently developed with the purpose of sharing, improving and replicating the experience of the R. Sarda Maternity.
In 2006, the first guide to transform traditional maternities into family-centered maternities was published by Funlarguía and the National Ministry of Health. This document synthesizes the international and national legal framework that supports the 'family-centered' concept and describes the actions that facilitate the maternity hospital transformation. Ten basic steps based on the continuity of care that follows from the first contact of the pregnant woman with the maternity and ends with the discharge during ambulatory follow up were described. In late 2008, the Argentine subsidiary of Panamerican Health Organization (PAHO), provided a detailed description of the SFCMH initiative and considered it as a best practice to be highlighted in Latin America.
The FUNLARGUIA team is continuously looking for new ways to improve pre-natal indicators in Argentina, Latin America and any other countries where people seek their support.
This work requires education and support to refine implementation strategies, best practices, sharing, and funding.