Reducing Maternal Mortality: Progress at Last! Deborah Maine, DrPH AMDD Program, Columbia University Maternal Health Symposium Tokyo, June 2003 The Safe Motherhood Initiative (SMI) ・Early 1980s: maternal mortality (MM) studies in Ethiopia, Egypt, Bali, etc. ・1985: - 1st Inter-regional meeting on MM at WHO - "Where is the M in MCH?" The SMI (cont.) ・1987: Launching of the SMI in Nairobi ・1987-97: - many conferences - No clear strategy - few programs No Clear Strategy Family Planning Skilled Attendant Antenatal Care Social Mobilization TBA Training Referral Risk Screening Waiting Homes Strategy: key fact #1 We know what causes most maternal deaths : - Hemorrhage - Hypertensive diseases - Unsafe abortion - Infection - Prolonged labor Strategy: key fact #2 Most serious obstetric complications cannot be predicted or prevented But they can be treated Strategy: key fact #3 Therefore, All pregnant women Need access to Emergency Obstetric Care (EmOC) EmOC is the foundation Skilled Attendant Antenatal Care Social Mobilization TBA Training Referral Risk Screening Waiting Homes Emergency Obstetric Care Why we need field projects 1. To save women's lives !! 2. To involve governments, agencies 3. To gain experience 4. To identify policy barriers UN AGENCIES, NGOS HEALTH SYSTEMS DONOR AGENCIES POLICY FORUMS POLICY ADVOCACY Ob/Gyns Midwives ↑ DOCUMENTATION RESEARCH FIELD PROJECTS AMDD Program Started: May 1999 Funder: The Bill and Melinda Gates Foundation Budget $50 million for 5 years AMDD = AVERTING MATERNAL DEATH AND DISABILITY Our Goal Improve the: availability, quality and utilization of emergency obstetric care AMDD Structure Principal Investigators: A Rosenfield, D. Maine Program Director: D. Maine ・Small staff at Columbia University ・Work through "project partners" ・Involve "technical partners" AMDD Project Partners ・UNICEF ・UNFPA ・CARE ・Save the Children (USA) ・RPMM Network in Africa ・RHR Consortium AMDD Technical Partners ・Family Health International ・EngenderHealth ・John Snow Inc. ・Johns Hopkins University ・Indian Institute of Management AMDD-Supported Projects 83 projects in 51 countries UNICEF = oldest, largest partner - Field Projects in Asia: ・Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka, Afghanistan - Needs assessments in Africa: Benin, Chad, Guinea, Mali, Uganda.... Lessons learned Improving services is much more that just training and equipment Implementing EmOC Improving Utilization On-site Quality Clinical Support On-going Readiness 24/7 EmOC Staffing Training Team Building Renovation Supplies & Equipment Facility Setup Data Collection Good News! You don't need to do it all at once, or all yourself. Use PARTNERSHIPS Partnership example: UNICEF role Improving Utilization On-site Quality Clinical Support On-going Readiness 24/7 EmOC Training Staffing Team Building Renovation Supplies & Equipment Facility Setup Data Collection Partnership example: Japan's role Improving Utilization On-site Quality Clinical Support On-going Readiness 24/7 EmOC Training Staffing Team Building Renovation Supplies & Equipment Facility Setup Data Collection Partnership example: Japan & UNICEF Improving Utilization On-site Quality Clinical Support On-going Readiness 24/7 EmOC Training Staffing Team Building Renovation Supplies & Equipment Facility Setup Data Collection Conclusion There is now a global momentum, based on learning from field project, involving governments, UN agencies, NGOs collaborating to improve EmOC. Conclusion (cont.) Partnerships such as that between the Government of Japan and UNICEF can lead to real progress in reducing maternal deaths, at last.