Using an evidence-based information system to strengthen maternal and child health services

The Government of Dominica prioritized the elimination of mother-to-child transmission of HIV and syphilis as a strategic policy initiative to improve the quality of MCH services. In 2021, the combined efforts of Dominica’s Ministry of Health, the Pan American Health Organization/World Health Organization (PAHO/WHO) Office for Barbados and the Eastern Caribbean Countries (ECC), and the PAHO/WHO Office of the Caribbean Subregional Program Coordination co-located in Barbados paid off when Dominica was certified by WHO for the elimination of mother-to-child transmission of HIV and syphilis in the midst of the COVID-19 pandemic. Dominica joined the ranks of seven other Caribbean countries having received dual validation. Critical to achieving certification was the introduction and roll-out of the Perinatal Information System, developed by the PAHO Latin American Center of Perinatology, Women and Reproductive Health, which consolidates health information on pregnant women and newborn babies. 

Technical and financial support for the Perinatal Information System was provided by the PAHO/WHO Office for Barbados and the ECC, in collaboration with the Latin American Center of Perinatology, Women and Reproductive Health, for in-country training, monitoring, software installation, consultations, design of the antenatal record, updating data in the system, and discussions for the roll-out strategy.

“Eliminating mother-to-child transmission of HIV and syphilis as a public health concern requires the strengthening of primary prevention and treatment services for HIV and syphilis for pregnant women within an established and successful maternal, perinatal and child health services.”

Roosevelt Skerrit
Prime Minister of Dominica

Inadequate quality, timely and reliable health information on pregnant women and newborns hindered the elimination of mother-to-child transmission of HIV and syphilis. Dominica’s Ministry of Health and the PAHO/WHO Country Office put in place the Perinatal Information System Plus version to improve monitoring of maternal and child health data. Ten countries in the WHO Region of the Americas used the Perinatal Information System Plus version, which allowed health administrators to learn more about the associated factors related to maternal and neonatal deaths and follow up to improve maternal and neonatal health. 

How did Dominica do it, and how did the WHO Secretariat support Dominica?

• National level commitment – Dedication to no child being born with HIV or congenital syphilis must be rooted in antenatal care, equitable access to care for women with HIV and human rights. As the WHO Country Office’s main partner, the Ministry of Health took ownership of the Perinatal Information System Plus program to derive the benefits in the area of perinatal care.

• Roll-out of the Perinatal Information System Plus – Roll-out enabled maternal and child health data to be collected in a systematic way, used to inform planning and programming, and used to monitor and improve care for maternal and child health. The Perinatal Information System Plus is now used as the medical record for prenatal, delivery, intrapartum, and neonatal periods. The Perinatal Information System is low-cost and easy to use.

• Health worker capacity building - Training on the use of the Perinatal Information System Plus involved health workers in data collection and analysis, enabling them to improve maternal and child health through monitoring and evaluation, quality of care assessment, and diagnostic procedures.

“The Perinatal Information System allows for the automatic collection and consolidation of data to analyze the health situation and make informed decisions about strategies and policies that can save newborn lives.”

Dr Jose Luis Diaz Rossello
Training instructor in Dominica

• Strengthened maternal and child health services - The Ministry of Health commitment to roll out the Perinatal Information System contributed to the certification of the elimination of mother-to-child transmission of HIV and syphilis.

Challenges encountered in rolling out the Perinatal Information System and solutions included:

1. Unreliable internet connection which can be solved by nurses updating information at clinics. In response, the Ministry of Health outlined a plan to have all clinics connected to internet services.
2. Regular rotation of health care workers which can be solved through continuous training.
3. Absence of a unique identification number in the Perinatal Information System Plus system was addressed by developing a coding system. The Ministry of Health also started developing and using an electronic immunization software on an open platform. The Perinatal Information System Plus will be added to this electronic system using one unique identifier for all services accessed per patient.

Dominica’s success to ensure that no child will be born with HIV or syphilis brings the country one step closer to achieving an AIDS-free generation and ending the disease. Success was the result of strong government leadership and the technical and resource contributions of PAHO/WHO, in particular, to develop, implement and ensure the smooth operation of the Perinatal Information System Plus.