Building Partnerships to Reduce Maternal Mortality Reflections on UNICEF’s Experience in Egypt 1990-2001 Leila Bisharat SHARED GOALS 1990 - 2000 World Summit for Children Halve Maternal Mortality Levels 2015 MILLENNIUM DEVELOPMENT GOAL Reduce the Maternal Mortality Ratio by three quarters National Leadership • International and National Partnerships • Scientists in Partnership with the Medical Community • Health Care Leadership • Linked Community and National Partnerships Women and their Families PARTNERSHIPS Leadership. . World Summit for Children 1990 Egypt One of Six Initiator Countries National Plan of Action National Council for Childhood and Motherhhod • Fostering a Culture of Assessments for Problem Identification and Action • Problem Recognition by Stakeholders • Strategy to Address the Problem • Building Improved Performance Using Process Indicators Scientists in Partnership with the Medical Community Assessments for Analysis and Action Government of Egypt 300 250 Priority to 200 150 Measurement 100 Tracking Progress 50 IMR U5MR 0 2000 1995 1990 1980 1970 1960 Recognition of the Divide between Upper and Lower Egypt Focus on Upper Egypt = 1992/1993 Maternal Mortality Audit Shocks Egypt’s Medical Community Substandard Care by 92 % of Deaths from Avoidable Causes Obstetricians 146 146 146 M aternal M aternal M ortality Ratio M ortality Ratio 152 152 152 281 281 281 171 171 171 325 325 325 213 213 213 117 117 117 N ational N ational 200 200 200 564 564 564 147 147 147 233 Metropolitan 151 151 151 174/100,000 174/100,000 217 Upper 151 151 151 132 Lower 544 544 544 250 150 200 100 50 0 MMR 307 307 307 386 386 386 135 135 135 Source: National Maternal t Mor Source: National Maternal Mortality Study, MOHP 1992 ality Study, MOHP 1992-93 93 Search for A National Strategy • Focus on Emergency Obstetric Response • Guidance from Columbia University • Emphasis on Upper Egypt • Healthy Mother Healthy Child Grant to UNICEF from USAID 1996-2001 • Healthy Mother Healthy Child Technical Support Contract from USAID to JSI Strategy • Assess Facility and Human Resource Capacity • Identify Potential Leaders • Support Leadership Teams in Facilities • Improve Conditions for Staff and Patients • Link to Mentoring Partnerships with Medical Schools • Involve Local Leaders Administrators and Engineers Delivery Room Sohag AFTER BEFORE M aternal M aternal M ortality Ratio M ortality Ratio N ational 2000 N ational 2000 48 84 0 ,0 0 0 1 / 84/100,0000 89 93 60 60 60 0 50 100 M M R 77 77 77 61 61 61 73 73 73 Source: National Maternal t Mor Source: National Maternal Mortality Study, MOHP 2000 ality Study, MOHP 2000 Upper and Lower Egypt 250 200 150 100 50 0 174 National Lower 217 132 93 84 Upper Egypt Egypt 59% Reduction 89 1992/93 NMMS 2000 NMMS Access to Quality Emergency Obstetric Care Percentage of births assisted by trained medical providers 64 57 55 44 33 23 32 33 26 24 23 14 99 98 97 95 92 88 Rural Lower Egypt Rural Upper Egypt 70 60 50 40 30 20 10 0 Safe Motherhood Council Decentralized Budget Authority “Unmet Need” Powerful Indicator for Mobilizing Awareness and Action Decision to Drop TBA Training Community Awareness for Referrals after EmOC in Place Competency-Based Standards and Training WFP UNIC WHO UN Partnerships ITU FAO UNICEF ILO UNDP UNHCR UNIDO UPU IOM UNESCO UNIFEM UNFPA World Bank IMF Donor Group USAID UN Norway Germany UK/DFID EU Gulf States Holland Japan NGOs Denmark Norway Sweden Italy