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Press Release

IHI and Brazil’s Hospital Israelita Albert Einstein Expand Successful Approach to Reduce Unnecessary C-Sections

Institute for Healthcare Improvement
Posted on: 28 Aug 17

Despite having the world’s highest cesarean section rates for decades, there’s now evidence the country of Brazil can reverse this trend. Building on the work of a successful 18-month demonstration project, today the Institute for Healthcare Improvement (IHI) and Brazil’s Hospital Israelita Albert Einstein (HIAE) announced they have received $1.5 million in funding from Merck for Mothers* for a continuation of Projeto Parto Adequado (PPA), which encourages vaginal birth among low-risk women in public and private hospitals in Brazil. In Phase I of the project, the partner organizations – IHI, HIAE, the Brazilian Regulatory Agency for the Private Healthcare Sector (ANS), and the Brazilian Ministry of Health – successfully increased the rate of vaginal birth from 21.6% to 38% over 18 months in 26 public and private hospitals. This achievement was just shy of the 40% goal of the initiative. With this new funding, Phase II will apply the methods used and lessons learned to expand the initiative to an additional 137 hospitals across Brazil.

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“We are honored to be part of this movement that is reversing Brazil’s historical trend for routine C-sections and offering mothers the optimal way to deliver a baby – natural delivery – unless a C-section is medically warranted. We pay tribute to our dedicated partners who are up for the challenge of scaling this successful approach to another 137 hospitals,” stated Pedro Delgado, Head of Europe and Latin America Regions, IHI.

Paulo Borem, MD, Project Director, Latin America Region, IHI added: “This second phase of the project will bring us one step closer to our goal of spreading this knowledge and experience to every corner of Brazil, to other countries throughout Latin America, and across the world to countries that have high rates of medically unnecessary C-sections.”

Launched in May 2015, Phase I of Projeto Parto Adequado began with an 18-month demonstration project that engaged 26 private and public hospitals across Brazil. The initiative was designed, coordinated, and delivered by the coalition of IHI, ANS, HIAE, the Brazilian Ministry of Health, private and public-sector hospitals, regulators, insurers, providers, health system administrators, and mothers’ groups. Using a quality improvement (QI) approach that included an ambitious shared aim, IHI’s Breakthrough Series Collaborative design, and improvement science as a method to implement changes systematically, the demonstration project increased vaginal birth rates for low-risk mothers, almost doubling the rate over 18 months.

In this newly funded Phase II, the 137 hospitals are being supported by the same partner organizations involved in Phase I, plus they’ll be joined by ten designated hospital “hubs” that have been trained to run their own projects based on the IHI Collaborative methodology for groups of 10 to 15 hospitals throughout Brazil. The name of the Phase II initiative is changing from “Project” (Projeto) to “Program” (Programa), to convey a sense of the new scale – which is a step closer to the national scale-up of this work expected to begin in 2019, after Phase II is completed.

According to Rita Sanchez, MD, Parto Adequado Clinical Lead, Hospital Israelita Albert Einstein, “Rapid-cycle testing throughout Phase I refined our theory of change, and helped us hone in on a set of key drivers and specific change ideas that we expect will continue to have the most impact throughout Phase II. Key changes include a reorganization of care delivery toward multidisciplinary teams rather than an overreliance on obstetricians, as well as the use of nonpharmacological methods to manage pain. Most importantly, women must have access to appropriate evidence-based information and their desire must be respected. We want to see less intervention and more focus on what matters to pregnant women and their families.”

“The death of a woman from complications during pregnancy and childbirth is one of the world’s oldest and most preventable global health tragedies, said Guilherme Leser, Executive Director of Policy & Communications for Merck. “Merck for Mothers is proud to support the Parto Adequado program that will help increase vaginal deliveries for low-risk mothers. We believe one of the best ways we can improve health outcomes for mothers in Brazil is by partnering with visionary institutions such as IHI and Einstein.”

This week in São Paulo, IHI and Hospital Israelita Albert Einstein are hosting the 3rd Latin American Forum on Quality and Safety in Healthcare (August 28-30, 2017), the largest conference in Latin America focused on these important topics. During the conference, the Programa Parto Adequado participating hospitals and funding organizations will host a Parto Adequado Lounge open to all Latin American Forum attendees. In addition to offering a space for an “all teach, all learn” exchange on the topic of improving vaginal births and reducing medically unnecessary C-sections, the lounge will display data on the work to date, program updates, and information on the methodology for Phase II.

IHI is working with health sector stakeholders in Latin America, from students to senior leaders, to generate actions that lead to tangible improvements in safety and quality to address existing health and health care gaps. For more on IHI’s work in Latin America, visit or contact

* This program is supported by funding from Merck, through Merck for Mothers, the company’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, USA.

About Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE)
The SBIBAE operates in three integrated and equally important fronts: health care, social responsibility and the generation and dissemination of knowledge. The activities of health care are concentrated in the Hospital Israelita Albert Einstein and in the area of ambulatorial and diagnostic medicine, that contribute to the sustainability of social responsibility, teaching and research. The Instituto Israelita de Responsabilidade Social Albert Einstein (IIRS) works in its own programs or in conjunction with public health system to help meet the health care needs, or technological skills of the community. The research and education activities are housed in the Instituto Israelita de Ensino e Pesquisa (IIEP) and confer innovation to other areas of SBIBAE.

About the Institute for Healthcare Improvement
IHI is a leader in health and health care improvement worldwide. For more than 25 years, IHI has partnered with visionaries, leaders, and front-line practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations. Recognized as an innovator, convener, trustworthy partner, and driver of results, IHI is the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health and health care profoundly for the better. Learn more at

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Last updated on: 28/08/2017

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