About 15 percent of women develop complications during pregnancy or after giving birth, leading to the deaths of 280,000 women and 3 million newborns each year. Millions more are disabled.
The vast majority of these deaths and disabilities are avoidable. While most life-threatening complications during pregnancy and childbirth cannot be predicted or prevented, nearly all can be successfully treated with effective, timely emergency obstetric and newborn care (EmONC).
Women in high-income countries have had access to EmONC for decades. But in developing countries, where 99 percent of the world’s maternal deaths occur, health systems are often too weak to provide such care.
Evaluating emergency services for women and newborns
AMDD provides technical expertise to develop comprehensive EmONC needs assessment tools and methodologies. AMDD supports ministries of health and other government agencies, often in partnership with United Nations agencies, donors and nongovernmental organizations, to conduct needs assessments in countries with high maternal mortality. Needs assessments evaluate how well and to what extent the health system is providing EmONC.
Needs assessments provide details about gaps or problems in the availability of EmONC services and newborn care. Qualitative and quantitative data are a first and critical step to improving equitable access to EmONC and to strengthening the overall health system, as they are the foundation of a rigorous planning process. This information enables ministries of health to identify low-functioning hospitals and strategic health centers that should be upgraded or re-positioned.
Promoting a practical tool to strengthen access
The needs assessment is a practical planning and monitoring tool that helps governments understand what is happening inside health facilities. It is a survey of health facilities (health centers and hospitals) throughout the country that helps answer questions such as:
Are there enough facilities providing EmONC?
Do facilities have adequate numbers of health workers with the right mix of skills?
Are the right women, meaning those with obstetric complications, using the facilities?
Is the quality of services adequate?
The needs assessment also covers much more than EmONC; it includes other areas of reproductive health such as non-emergency obstetric care, prenatal care, family planning, infection prevention, and HIV prevention, care, and treatment.
Making a Difference
How needs assessment results make a difference
National and district health officials use the needs assessment data to guide policy, planning, and budgeting to strengthen the health system and improve EmONC services. For example, the data directly impact program planning by showing unacceptably low levels of EmONC utilization, identifying areas within the health system that require particular attention. At the national policy level, government officials have assigned higher priority to emergency services for women and newborns based on needs assessment data.
After helping conduct needs assessments, AMDD has directly assisted over two-dozen governments in developing national programs to improve emergency obstetric care.
Results on the ground: Ethiopia
In 2009, AMDD supported the Ethiopian Federal Ministry of Health (FMOH) in conducting a needs assessment of the country's maternity services; the assessment revealed that an inadequate water supply was in part preventing facilities from providing quality EmONC. In response, UN agencies helped the country develop a strategy to provide water to all facilities without running water.
Because of its integral role in the 2009 needs assessment, AMDD was asked to provide technical assistance to the FMOH’s 2015 national EmONC assessment. Throughout this assessment, AMDD has provided continuous support, both remotely and in-country, in tool adaptation, tablet-based electronic data collection training, data analysis, report writing, mapping of national EmONC services, and evidence-based action planning. Upon completion of the assessment, the FMOH aims to use results from the assessment to finalize its newest health sector plan on reproductive, maternal, neonatal, child, adolescent and youth health.
Results on the ground: Angola
In Angola, the 2007 Needs Assessment results showed that certain regions had a much lower maternal death rate from the obstetric complication, eclampsia. After further investigation, the Angolan Government determined that these regions had better access to the anti-convulsant drug, magnesium sulfate, knowledge useful for improving the region's EmOC services.
Other Contributions to EmONC
Since 2015, AMDD has been engaged in developing a comprehensive maternal health global monitoring and reporting framework with the WHO’s Ending Preventable Maternal Mortality (EPMM) Working Group. Phase I of EPMM indicator development entailed the identification of a core set of 12 metrics for global monitoring and reporting: a recently published article describes the process. Phase II identified a set of “means of implementation” indicators for tracking progress in key areas, as well as indicators for further development; these will be shared with the WHO’s recently-formed Mother Newborn Information for Tracking Outcomes and Results (MONITOR) expert advisory group. AMDD was represented on the Steering Committee for both phases of development, and has participated in multiple consultation meetings.