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Using UN process indicators assess needs in emergency obstetric services:Gabon, Guinea-Bissau, and The Gambia.
International Journal of Gynecology and Obstetrics. 2007 Mar; 96(3):233-240.We report on assessments of the needs for emergency obstetric care in 3 West African countries. All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries. (author's)
Making safe motherhood a reality in West Africa. Using indicators to programme for results. [Pour que la maternité sans risque devienne une réalité en Afrique de l'Ouest. Le recours à des indicateurs nécessitant d'être développés en vue de l'obtention de résultats]
New York, New York, UNFPA, 2003. 31 p.For too long, maternal mortality reduction efforts stalled, in large part because the facts underlying the problem—and the best strategies to address it—were poorly understood. That is why we are so proud to present this report as the first outcome of a collaborative effort between UNFPA and the Governments of Cameroon, Côte d’Ivoire, Mauritania, Niger and Senegal. This report is a tangible reflection of our determination to address maternal mortality using a strategic and practical evidence- based approach in a region where data has been scarce, and where too many women have died. This document represents the first careful assessment of obstetric services in these five countries using emergency obstetric care process indicators. Process indicators assess the critical emergency obstetric care functions that should be made available to all women experiencing complications of pregnancy. These indicators are sensitive, relatively easy to collect, and therefore suitable for monitoring progress in our collective fight against maternal mortality and morbidity. Most important, they can identify problems and suggest their amelioration within a fairly short period of time. This can help programme managers stay on track and save women’s lives. In the countries surveyed, Ministries of Health collaborated with UNFPA and played leadership roles during national workshops aimed at sharing the assessments with other agencies involved in safe motherhood programmes, including WHO and UNICEF. This kind of collaboration and knowledge sharing is extremely useful for strengthening programmes. It not only ensures full ownership of the process but also spotlights those services that need urgent attention by all partners. Malawi and Morocco, which earlier carried out similar initiatives, contributed to the process by sharing their experiences in collecting and using process indicators at the methodology workshop that launched this project. Since then, word of these studies has spread to other countries, and The Gambia, Gabon and Guinea-Bissau are replicating this exercise, with UNFPA support. This phased approach means we can continue to build on past efforts and to use our resources effectively as we move forward. Our hope is that many other partners will support the respective Governments in their efforts to reduce maternal mortality rates as part of our commitment to the Millennium Development Goals. The Maternal Mortality Update 2002, which is published as a companion piece to this report, documents other efforts of UNFPA to make childbearing safer for women around the world. Together these documents underscore UNFPA’s larger commitment to fulfilling women’s right to life and reproductive health. (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)
SAFE MOTHERHOOD. 1996; (20):10.During a 1994 workshop sponsored by the World Health Organization and the International Federation of Gynaecology and Obstetrics (FIGO), participants discussed 1) women's right to family planning information, education, and services; 2) women's right to a choice of options and to voluntary decisions concerning their health; and 3) the link between women's rights and women's health. Participants noted that obstetricians and gynecologists must expand their role to become women's advocates and must insure that women's rights to informed choice and informed consent are protected. Women should participate as equals in the planning, implementation, and evaluation of policies which affect them so that they can make fully informed decisions. The workshop produced the following recommendations: 1) FIGO should discourage practices that abuse women's rights to information and education on the procedures and treatments they face; 2) adolescents should receive reproductive health information, counseling, and services; 3) obstetricians and gynecologists should be trained in communication and counseling skills; and 4) national societies of obstetricians and gynecologists should encourage the provision of comprehensive reproductive health services, discourage female genital mutilation, and encourage provision of counseling for female victims of violence.