Averting Maternal Death and Disability (AMDD)

Emergency Obstetric and Newborn Care

About 15 percent of women develop complications during pregnancy or after giving birth, leading to the deaths of 303,000 women each year. In addition, 2.7 million newborns die each year, and 2.6 million are stillborn. Millions more mothers and babies 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).

In LMICs, where 99 percent of the world’s maternal deaths occur, health systems are often too weak to provide such care.

Needs Assessments

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.

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.

AMDD’s EmONC Needs Assessment Toolkit contains documents needed to plan for and conduct an EmONC needs assessment. If you are interested in accessing AMDD’s toolkit in English or French, please email amdd@columbia.edu.

Making a Difference

HOW NEEDS ASSESSMENT RESULTS MAKE A DIFFERENCE

Having data on EmONC is not enough; governments need to utilize the data to affect change. The benefit of EmONC needs assessments is that they help to identify gaps in coverage that allow governments to tailor their health system strengthening efforts to target those areas most in need of improvement. National and district health officials can use the needs assessment data to guide policy, planning, and budgeting to strengthen the health system and improve EmONC services. 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 2008, AMDD supported the Ethiopian Federal Ministry of Health (FMOH) in conducting a national EmONC needs assessment. The 2008 needs 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 2008 needs assessment, AMDD was asked to provide technical assistance to the FMOH’s 2016 national EmONC assessment. Throughout this assessment, AMDD 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. Since completion of the assessment, the FMOH has used the data to guide facility-level planning, and also aims to use results from the assessment to inform its newest health sector plan on reproductive, maternal, neonatal, child, adolescent and youth health.

Other Contributions to EmONC

AMDD supports ongoing efforts to assess and improve EmONC. Over the past year, AMDD has supported the development of 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; an article published in 2016 in BMC Pregnancy and Childbirth 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; Phase II is described in this article.

AMDD is also co-leading a global technical working group on EmONC indicators and signal functions. The goal of this working group is to review and harmonize the EmONC indicators and signal functions, integrate signal functions for newborns, and revise the ‘Monitoring Emergency Obstetric Care’ handbook to include updated evidence and reflect lessons learned since the last revision in 2009. The working group includes representatives from EPMM, ENAP, UNFPA, LSHTM, UNICEF, MHTF, USAID, and other organizations working on emergency obstetric care.

Resources

Visit our toolkit page for tools and guidelines on conducting needs assessments.

Download our Emergency Obstetric and Newborn Care Brief.

Articles:

Sign up for our mailing list today.

Sign Up Now