The Maternal and Child Centers of Excellence project, recently awarded to Abt Associates by USAID, addresses a joint goal of USAID and the Dominican Republic: improve the health status and lives of the people of the country by increasing their access to quality maternal and child care — with the ultimate objective of reducing maternal and child morbidity and mortality. The project will support the Government of the Dominican Republic by focusing on critical interventions and management improvements that emphasize quality and efficiency, thereby improving equitable access to quality maternal and child health (MCH) services. The program is built on previous successful models in both MCH and health systems. It will continue to support the gradual implementation of the Family Health Insurance Program under the subsidized scheme, to guarantee financial access to health care for poor families, while strengthening the capacity of service providers to deliver efficient, high-quality, and timely care. An important focus of the project will be on integrating its two core components: MCH Service Strengthening (Component 1) and Health Systems Strengthening (Component 2). This integration is the basis of the design and development of Centers of Excellence in hospitals and Direcciones Provinciales de Salud (DPSs). The project will develop 10 Centers of Excellence in strategically selected hospitals and DPSs. These will be the vehicles for both expanding equitable access to quality MCH services and disseminating best practices throughout the country. While the main thrust of this effort is on developing Centers of Excellence, project staff will also work on:

• strengthening social participation in health promotion,
• increasing demand for vaccination,
• developing better-educated consumers, and
• promoting social oversight and control.

This approach will ultimately contribute to reduced maternal, neonatal and child morbidity and mortality. The Abt Associates team partnered with staff from selected Centers of Excellence to apply the Common Assessment Framework (CAF) — a methodology that the Government of the Dominican Republic has favored since 2004 to improve the quality of services in its public sector institutions. The approach used on this project relied heavily on in-country expertise (both institutions and personnel), with minimal international short-term technical assistance. Abt Associates partnered with several Dominican institutions, including Universidad Instituto Tecnológico de Santo Domingo (INTEC), Sistemas y Procedimientos, S.A. (SISPROSA), and Demographic and Social Studies Consultants — DR (CESDEM). Abt Associates also brought international partners of high prestige, including the Health Services Institute (CES) and Cultural Practice. Centers of Excellence: Functions

• Consolidate, develop, and disseminate managerial and technical best practices
• Serve as regionally based hands-on training centers to cost-efficiently and effectively improve service quality (maximizing the impact of USAID assistance)
• Deliver high-quality, well-regarded, and cost-efficient evidence-based health care
• Build critical community networks both supporting and empowered by the Centers of Excellence, to further local stewardship of the health sector
• Extend the success of two earlier USAID-funded projects, REDSALUD and CONECTA, and derive methods of measuring USAID’s impact
• Develop sustainable communication strategies and networks to generate demand for quality services, necessary behavior change, and improved community health education
• Create a replicable model for continual managerial and technical improvement, which can be scaled up nationwide in close coordination with other donor entities and projects

  Experience in the Dominican Republic has shown that the basic engine of sustainable reform rests at the local level, where governance, management, demand for quality, and improved access can best be realized. Health care providers have begun to embrace a client-oriented culture. Accurate data on vital registration, hospital productivity, and clinical outcomes have been used to improve both the quality of health care services, and the efficiency with which scarce resources are allocated. A cadre of health care professionals have developed clinical and management knowledge and skills that they not only use daily but also disseminate as they mentor health professionals in hospitals.  The scale-up of reforms continues.