Despite Establishing Cumulative Sum (CUSUM) charts for relevant quality indicators holds considerable promise for continuously assessing and improving the quality of care, nowadays, there are no studies that assess the impact of the CUSUM chart on mother and children health. The most published studies used CUmulative SUM (CUSUM) to see the behaviour of an indicator, but do not exploit the Cumulative Sum (CUSUM) as a SPC (statistical process control)tool