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Section A - Policy

16. Specific Programs & Technical Details

Appendix 5-Maternity Services Enhancement Strategy

1. Objectives of the Strategy

• To promote measurable improvements in the continuum and quality of antenatal, intrapartum and postnatal care that meets the clinical and psychosocial needs of women;
• To provide women with better information about their care choices, and with evidence based information on the benefits and risks associated with different care options;
• To encourage service providers to improve models of care in line with best available evidence on service effectiveness; and
• To improve services and health outcomes through further development and use of performance measures and service audits.

2. Funding for 1999-2000

The budget for 1999-2000, the second year of the Maternity Services Enhancement Strategy, is $16.4 million.

$14.3 million will be allocated to Networks and hospitals in the form of specified grants based on the number of births in hospitals in 1998. This funding combines the previous year's separate allocations for postnatal and antenatal care.

Allocations for maternity services have been incorporated into the modelled budgets for the Networks and notionally set for rural hospitals. Final allocations for rural hospitals will be determined by Regional Offices.

3. Requirements for Maternity Services Enhancement Plans

Hospitals are required to demonstrate measurable improvement across the spectrum of maternity care in line with agreed Maternity Services Enhancement Plans.

Plans are expected to lead to:

• Increased levels of antenatal and postnatal services;
• A wider range in the models of maternity care offered to women;
• Increased continuity of care, with respect to hospital care and integration with the community provision of antenatal and postnatal care and support;
• Improved responsiveness to women with special needs;
• Improved arrangements for monitoring, review and improvement in the quality of care; and
• Greater opportunities for consumers to make informed choices, participate in decision making and provide feedback for service improvement

A particular requirement is to ensure adequate postnatal care for women and their families according to clinical and psycho-social needs. This is defined as offering as a minimum:

• At least one postnatal home visit for all women following discharge from hospital and more depending on postnatal length of stay in hospital;
• At least two postnatal home visits or more if required for women with special needs, such as women from diverse cultural backgrounds, newly arrived migrants, single young mothers, women with disabilities and first time mothers; and
• At least two or more postnatal home visits for women after a caesarean section, or with complications arising from the birth or immediate postnatal period.

4. Services for Koori Women

Levels of participation in antenatal care are lower amongst Aboriginal and Torres Strait Islander women, and birthing and postnatal health outcomes tend to be poorer for these indigenous women and their babies. Under the Commonwealth Birthing Services Program in Victoria, there have been several successful pilots of antenatal and postnatal support provided by Aboriginal and Torres Strait Islander health workers in collaboration with hospitals and community medical services. Commencing in 1999-2000, recurrent funding of $0.6million will be provided to enhance existing community based Koori health services in providing additional and culturally appropriate support to Koori women during pregnancy, birth and the postnatal period.

5. Effectiveness of Maternity Care

The Department wishes to collaborate with clinicians and health care managers; with consumers; with community providers; and with colleges and other professional organisations to improve the effectiveness of maternity care across the state over the remaining three years.

In 1998-99, fifteen short term projects and two three year programs were funded through networks and rural regions to improve the quality of maternity services in Victoria. The focus of these projects is integration of available knowledge on effectiveness into routine service delivery, and/or improved continuity and safety of care. Five of the projects focus on breastfeeding and will work cooperatively to maximise the potential benefits for all hospitals. Other projects are concerned with various aspects of antenatal care and antenatal risk, better coordination between maternity services, improving discharge planning and implementing effective links with maternal and child health services.

The Southern Health Care Network has been funded for a three year program to evaluate an enhanced model of care, emphasising continuity of care. This program aims to monitor the process of implementing the new initiatives and to evaluate the effectiveness of the innovations by assessing their impact on women's views and experiences of care. A three year program at The Royal Women's Hospital aims to improve access to maternity services aboriginal women, as well as , piloting and evaluating appropriate models of care for women affected by female genital mutilation and for women with mild intellectual disabilities.

It is intended that these projects will result in findings that will be of potential benefit to all other public maternity hospitals in Victoria. A workshop open to all public maternity hospitals will be convened in 1999-2000 to enable the findings of projects to be presented and promote networking between hospitals on issues of common interest.

6. State wide Initiatives

In 1998-99 hospitals participated in a review of antenatal shared care conducted by the Centre for Mothers and Children's Health. The recommendations of this review will be circulated to all hospitals, to inform service improvement. Other activities to be undertaken in 1999-2000 include:

• The convening of an Expert Maternity Services Enhancement Strategy Reference Group;
• A replication of Study of Recent Mothers, conducted by the Centre for the Study of Mothers' and Children's Health and the development of a maternity consumer satisfaction survey for use by individual hospitals;
• A series of forums on common issues identified through the Strategy such as maternity services for women with chemical dependency;
• Examination of issues relating to caesarean section rates;
• Investigation of evidence based practice in antenatal care;
• Further development of performance indicators; and
• Work on consumer information to ensure that up to date evidence on pregnancy and child birth is available to women.

Hospitals will be expected to participate and collaborate in research and evaluation conducted as part of the maternity services enhancement strategy.

7. Reporting Requirements

Implementation of Plans

Hospitals are required to report on improvement in services according to measures outlined in Maternity Service Enhancement Plans. A format for annual reporting will be provided in July 1999.

Postnatal Domiciliary Care

Hospitals are required to provide patient level data on postnatal domiciliary care through the Agency Information Management System : Domiciliary Postnatal Services: Form 111/D1.

8. Contact Persons

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