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The United Nations Process Indicators for emergency obstetric care: Reflections based on a decade of experience.
International Journal of Gynecology and Obstetrics. 2006 Nov; 95(2):192-208.The paper reviews the experience with the EmOC process indicators, and evaluates whether the indicators serve the purposes for which they were originally created -- to gather and interpret relatively accessible data to design and implement EmOC service programs. We review experience with each of the 6 process indicators individually, and monitoring change over time, at the level of the facility and at the level of a region or country. We identify problems encountered in the field with data collection and interpretation. While they have strengths and weaknesses, the process indicators in general serve the purposes for which they were developed. The data are easily collected, but some data problems were identified. We recommend several relatively minor modifications to improve data collection, interpretation and utility. The EmOC process indicators have been used successfully in a wide variety of settings. They describe vital elements of the health system and how well that system is functioning for women at risk of dying from major obstetric complications. (author's)
Program note: using UN process indicators to assess needs in emergency obstetric services: Benin and Chad.
International Journal of Gynecology and Obstetrics. 2004 Jul; 86(1):110-120.The major obstetric complications that are taken into consideration for the calculation of the process indicators are hemorrhage, sepsis, prolonged or obstructed labor, eclampsiaysevere pre-eclampsia, complications from abortion, ruptured uterus and ectopic pregnancy. The following brief reports present data from needs assessments conducted with the UN Process Indicators in Benin and Chad in 2003. In each case, they reflect 12 months of facility data. (excerpt)
Reproductive Health Matters. 2001 Nov; 9(18):191.In 1997 UN International Children's Fund, WHO, and UN Population Fund developed guidelines for monitoring obstetric services, offering relevant process indicators which used proxy measures for maternal mortality, because counting deaths had been highly inaccurate. The Malawi Safe Motherhood Project covers half the country's population of 5 million and was the first large project to adopt the use of the recommended indicators within routine monitoring procedures, albeit with significant adaptation. Development of the monitoring process required: a needs assessment, including identification of sources of data and definition of terms, such as for obstetric conditions; development of tools for data collection: and actual operations research. The research considered patient flow in obstetric clinics; recording of complications; and identification of maternal deaths, referral systems and the origin of patients, in order to determine the catchment populations for each service point. Subsequently, when the new monitoring system was deemed to be feasible and effective, training programs were conducted by trainers from each district, and information was disseminated. The intention is that the Safe Motherhood information system training modules will eventually be incorporated into all basic and in-services training for maternity staff. Introduction of the indicators in Malawi was characterized by wide consultation, systematic clarification of all definitions, rigorous testing and use of already established systems. All of these steps were required to gain support and motivate staff involved in data collection and analysis. (full text)
Care of mother and baby at the health centre: a practical guide. Report of a technical working group.
Geneva, Switzerland, WHO, Division of Family Health, Maternal Health and Safe Motherhood Programme, 1994. , 55 p. (Safe Motherhood Practical Guide; WHO/FHE/MSM/94.2)This report is designed for health planners and program managers to improve access to health and to decentralize maternal and newborn health care. It covers secondary care services that traditional birth attendants (TBAs), midwives, and other nonphysician health workers in health centers can perform. Specifically, it defines the tasks and skills required to provide comprehensive care of mother and infant at the health center and in the community. It also looks at the role of the health center in training, supervision, and continuing logistic support for community based care. The first chapter examines the health center's role in maternal health and the 3 approaches to integrated care: vertical integration, integration across time, and horizontal integration. The next chapter reviews the essential elements of obstetric and neonatal care, including sexually transmitted diseases and HIV/AIDS. Topics discussed in the chapter on developing and maintaining a functional referral system include referral protocols, functional links with referral centers, obstetric first aid, maternity waiting homes, transport and communication, and reception of referred cases in referral centers. Institutional support mechanisms (chapter 4) are training; teamwork and supervision; logistics, maintenance, and essential drugs and supplies; management, communication, and interpersonal skills; and data collection and research. Topics included in the chapter on community support systems are TBA training and retraining, integrating the TBA into the health care system, IEC, and community support mechanisms for the health of mothers and newborns. The last chapter revolves around evaluation and monitoring, including estimating catchment area and coverage, monitoring quality of care for mothers and newborns, performance indicators, record keeping, and home-based maternal records.