·(wp)rph/tcp/rph/002-e - world health organization
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·(WP)RPH/TCP/RPH/002-E
Report series number: RS/2000/GE/OS(PHL) English only
REPORT
WORKSHOP ON MATERNAL MORTALITY REDUCTION IN SELECTED COUNTRIES IN THE WESTERN PACIFIC REGION
Convened by:
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
and co-sponsored by:
UNITED NATIONS INTERNATIONAL CHILDREN'S FUND
Manila, Philippines 29 May -· 2 June 2000
Not for sale
Printed and distributed by:
World Health Organization Regional Office for the Western Pacific
Manila, Philippines
January 200 I
NOTE
The views expressed in this report are those of the participants in the Workshop on Maternal Mortality Reduction in Selected Countries in the Western Pacific Region.
This report has been prepared by the World Health Organization Regional Office for the Western
Pacific tor governments of Member States in the Region and f(H· those who participated in the
Workshop on Maternal Mortality Reduction in Selected Countries in the Western Pacific Region,
which was held in Manila, Philippines from 29 May to 2 June 2000.
SUMMARY ...... ...... ... ... ..... ... ..... ................ .. .... ...... ...... ...... ....... .. ...... ....... ..... ... ..... ........ .. ............ .. 1
I . INTRODUCTION .. ......... .... .... ........ ............. .... ... .... .. ............... ... .. ............. .... ....... ... ..... .... ..... 2
1.1 . Objectives ofthe workshop .......................... ........... ......................... ........ ............ , .. ...... 2 1.2 Participants and resource persons ................... ..... ... .... .. ............. .............. ....... ........... .. 2 1.3 . Organization ... .......................... ... .... .. ..... ... ... .. ......... .. .......... .. ........................... .... ... .... .. 2 1.4 Opening ceremony ....................... ......... ........... .... .. .. ..... .. .................. ... .... ....... .. ..... ...... . 3
2. PROCEEDINGS ....... .. ............... .. ... ...... .. ...... ............ ..... ... .... ..... .... .... ... .. .. ... ................. ... ...... ]
2.1 Summary of presentations .... .................... .......... .... ....... .. .... ... ....... ..... ............ ..... ... .... .. . 3 2.2 Summary of country repmts .... .. .... ...... ... ...... ... .... ..... .. ......... ........ ..... ... ....... ...... .... .. ... .... 7 2.3 Summary of discussions ............ .................. .. ........ ...... ......... .. ...... .. ......... ... ... .... ..... .. .. .. . 9 2.4 Evaluation of the workshop .............. .. .... .............. ....... .... .. ........... .............................. I 0
3. CONCLUSIONS .... ...... .... .. .. .. ....... .. .... .......... .... ... .. ... ..... ... .... ... .... ... ... ... ... .... ... ... ............ .. ... I 0
ANNEXES:
ANNEX I - LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT ...... ............. ... .... .. ..... 13
ANNEX 2 - AGENDA ............................. .... .. .. ....................................... ..... ... .............. 23
ANNEX 3 - OPENING REMARKS BY THE REGIONAL DIRECTOR rOR WHO REGIONAL DIRECTOR. DR SHIGERU OMI .... .. .............. 25
ANNEX 4 - DRAFT PLANS OF ACTION OF THE COUNTRIES .............. .......... .... _7
Keywords:
Maternal mortality I Maternal welfare I Western Pacitic
SUMMARY
There are approximately 600 000 women who arc estimated to die due to complications in childbirth and about 50 000 of these deaths are in the Western Pacific Region. There is a marked difference in maternalmmtality ratios (MMR) in the countries of the Region. For instance. the Lao People's Democratic Republic has one ofthe highest ratios of650 per 100 000 live births while Singapore has one of the lowest with only 4 per 100 000 live births. The maternal mottality refl ects a woman's basic health status, her access of health care and the quality of care that she receives. To support the countries in reducing maternal mortality, the WHO Regional Office for the Western Pacific held a workshop in Manila from 29 May to 2 June 2000. The countries selected for the workshop had the highest maternal mortality ratios in the Region. They were Cambodia, China. the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and VietNam . The goal ofthe workshop is to enable the countries to reduce maternal mortality by 30% by 2003 from the 1998 levels. The meeting was co-sponsored by UNICEF and other agencies like UNFPA, ADB and GTZ had also close working cooperation.
The objectives of the workshop were to:
(1) review the status of maternal health in participating countries;
(2) identify factors, which contribute to high maternal deaths;
(3) analyse their own country situations as regards the activities and interventions to promote safe motherhood:
( 4) update the participants on different strategies and programmes to reduce maternal mortality; and
(5) draft a national plan of action to reduce maternal mortality by year 2005 .
There were 29 participants from the seven countries. Several papers were presented by resource persons to update the participants on new strategies in maternal health. The country representatives then presented their reports as well as described their experiences on cettain issues like political commitments, community patticipation, etc. The major causes of maternal mortality are still PPH, eclampsia, sepsis. obstructed labour. malaria and anaemia. The main problems in most of the countries are budget constraints, inadequate political commitment, lack of drugs and equipment, lack of training, poor infrastructure, poor communications and low community involvement. The countries have several ongoing projects to reduce MMR. Their main aim in the workshop was to find out what needed to be done further to develop a Plan of Action so that representatives from international agencies could work on the programmes in the future. Agencies such as UNICEF, UNFPA, and ADB presented their roles and functions to help the countries. At the end of the workshop, the participants agreed on some major issues. One of the major conclusions is the formation of a network among the countries to exchange ideas and experiences to further reduce the mortality in each of the countries. For the network to function. each of the participating country will have to have a focal point and WHO will assist in this network to update information regularly.
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I. INTRODUCTION
A joint workshop organized by the WHO Regional Office for the Western Pacific Region
and UNICEF was held in Manila from 29 May to 2 June 2000. Seven countries with high
maternal mortality ratios attended the workshop. The countries are Cambodia, China, the Lao
People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and VietNam.
The workshop also received support and cooperation from UNFPA, ADB and GTZ.
1.1 Objectives:
General objective
The general objective of the workshop was to support priority countries in reducing
maternal mor1ality ratios ofthc 1998 levels by 30% by the year 2003.
Specific objective
After the workshop the participants:
(I) reviewed the status of maternal health in participating countries;
(2) identified factors which contributed to high maternal deaths;
( 3) analysed their own country situations as regards the activities and interventions to
promote safe motherhood;
( 4) were updated on the different strategies and programmes to reduce maternal
mortality; and
( 5) drafted national plans of action to reduce maternal mor1ality.
I .2 Participants and resource persons
The workshop was attended by 29 participants from the seven countries, I short-term
consultant, 2 temporary advisers, 6 representatives from UNICEF and UNFPA, 4 observers from
ADB, 2 resource persons and 9 Secretariat members from WHO, UNICEF and UNFPA. The
Director General of Health from Cambodia, Professor Eng Huot, was elected Chairman,
Professor Tran Thi Phoung Mai, Deputy Director of Maternal and Child Health/Family Planning
li·om VietNam the Vice-Chairperson and Dr Mathias Sapuri, Acting Dean from the Medical
School of Papua New Guinea, was elected Rapporteur. (Annex I)
l.3 Organization
The agenda of the workshop is given in Anne>. 2. The schedule of the workshop included
plenary sessions where several papers were presented and discussed. Dr Richard Guidotti and
Dr Omelia Lincetto from the WHO Headquarters also present~d papers. All countries present~d
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country reports. The country representatives then worked together, with suppott from the consultant and resource persons, to prepare plans of action to reduce maternal mortality for their own countries and this was presented on the last day. On the last day, conclusions vvere presented and they were agreed to by the country representatives. The consultant and temporary advisers assisted countries in drafting national plans while the UNICEF country representatives helped in identifying sources of funding.
1.4 Opening ceremony
Regional Director of WHO for the Western Pacific, Dr Shigeru Omi. opened the workshop. In his message, Dr Omi emphasized that maternal mortality is a major problem in the Western Pacific Region (Annex 3). Maternal mortality is the 'litmus test' ofthe status of women and that it is mutifactorial in origin and that although some factors are difficult to solve, we in the health sector, should do our utmost to further reduce the mortality rates. Dr Omi pointed out the need to 'rethink ' existing programmes to improve maternal health in the Region. The national governments should acknowledge that safe motherhood is a cost-effective, economic and social investment. With the participation of government decision-makers and experts in the workshop, WHO could determine the more urgent needs that required our attention. He also took the opportunity to inform the participants of the changes that have taken place in WHO since he took over. There has been a reduction in bureaucracy and more delegation and this has made the work flow smoother and quicker. He has also taken the initiative to intensify partnership with other UN agencies and nongovernmental organizations to reduce overlap of functions. This workshop was an example of the new partnership as several agencies supported and worked together to make this workshop a success. He said that 51 programmes in this Region were reduced to 14 to enable WHO to achieve concrete and tangible results. He also emphasized that while national governments were concentrating on the highly technical and medical aspects. they should not lose sight of political and health systems issues.
Dr Ray Yip, Senior Project Ofticer for Health and Nutrition, UNICEF Area office for China and Mongolia, thanked WHO for organizing the workshop. On behalf of UNICEF, he welcomed this cooperation and said that such cooperation should continue in the future. Learning and benefiting from each other is a wonderful way to work at the country level.
2. PROCEEDINGS
2.1 Summary of presentations
Summaries of the presentations made during the workshop are given below. Copies of the original papers are available in the Reproductive Health Unit of the WHO Western Pacific Regional office.
2.1.1 Dr Pang Ruyan, Regional Adviser in Reproductive Health ofthe WHO Regional Office for the Western Pacific, presented a paper entitled "Focus -Reproductive Health." ln her paper, she emphasized that there was a wide range of maternal mortality rates (MMR) in the Region and the countries represented in this workshop had the highest MMR in the Region. The overall average MMR in the Western Pacific Region was 120 per 100 000 live births. Although this was lower than the other Regions, we still have to play a proactive role to reduce maternal mortality
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further. She emphasized that Reproductive Health includes many other activities such as family health, safe motherhood, women's health care, infertility, prevention and control of
STI/HIV I A IDS, and abortion and management of its consequences. She discussed the mission
statement of the Reproductive Health focus, objectives and targets, strategies, expected results by
the year 200 I and 2003. She also discussed the external and internal linkages and monitoring and
evaluation of reproductive health and safe motherhood. She emphasized in her mission statement
that the goal of the Reproductive Health focus is to improve the status of women and infants . To
attain this goal, there is a need to mobilize government commitment, provide equitable and
accessible reproductive health care, strengthen capacity building, improve quality of care and promote reproductive health.
2.1 .2 Safe motherhood (UN lCEF perspective)
Dr Ray Yip recounted the UNICEF perspective on safe motherhood. Basically, there was
not much difference between the WHO strategy and the UNICEF strategy and he then presented
the outcome of the UNICEF workshop in Indonesia. The model is an accessibility model where
the strategy is based on an economic model and the three components of the model are supply,
demand and agent. On the supply side, there is the need to increase capacity building, quality and
affordability and it is important that the services are client-friendly. On the demand side, it is important that the women has basic knowledge, tinancial capacity and positive attitude to increase the demand and, finally, the agent is most important because it facilitates the link
between the demand and the supply side. In this case, the model is based on education,
communication and transportation. Each of these areas is linked and interdependent. He also
emphasized that among the major killers of pregnant women, obstructed labour and haemorrhage
need quicker response time as compared to toxaemia and sepsis. Toxaemia should be diagnosed
in antenatal care and appropriate treatment given. Sepsis is preventable.
2. 1.3 Making pregnancy safer
Making Pregnancy Safer (MPS) was presented by Dr Richard Guidotti, Medical Officer
from the Reproductive Health and Research Department of WHO Headquarters, Geneva. MPS is
a health sector strategy tor reducing maternal and perinatal morbidity and mortality by WHO and
pa11ners. Globally MPS falls under the bigger umbrella of Safe Motherhood strategy. The WHO
strate~:,ry of making pregnancy safer will work with other partners and agencies to achieve greater
access to essential maternal and perinatal care in SO priority countries by the end of 2005 . The
basic strategy is to promote partnership, establish norms, improve capacity, monitor and evaluate
the implementation of the strategy. The targets are that skilled attendants should be present at least 80% of births by year 2000 and 75% reduction in pregnancy-related mortality should be
achieved by the year 2015. Other targets include reduction in unwanted pregnancy and unsafe
abortion, and access to well-equipped facilities in complex emergencies. He also discussed the
causes of maternal deaths and their main interventions.
2. 1.4 Integrated management of pregnancy and childbirth (IMPAC)
The IM PAC strategy was discussed by Dr Orne II a Li ncetto, Medical Ofticer from the
Reproductive Health and Research Department of WHO Headquarters. She discussed the essential health sector interventions for safe motherhood. The IMPAC strategies mainly included
standardization of care by setting norms and standards, improving health worker skills, improving
health systems response and improving family and community practice. The first step in IMPAC
is to develop norms and standards. The approach is to provide primary care using Essential Care
Practice Guide (ECPG) and a manual for managing complications in referral hospitals thereby
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'improving the competence of health care providers. Every woman should have antenatal care. 'labour and delivery care, postpartum care, post abortion care, emergency care when needed and treatment at the higher level of care, ifrequired. It also strengthens community and family :support for healthy pregnancy outcome.
2.1.5 Essential care practice guide for pregnancy and child birth (ECPG)
Dr Lincetto talked about ECPG, which are guides for the essential standard care for women and newborn at the primary health care level during pregnancy, labour and delivery, and post partum period. The main objective is to manage routine labour and delivery, avoiding complications both for the mother and newborn, by recognizing the complications and referring them to higher levels of care and to avoid major pregnancy and birth complications. The main :ECPG are a chart booklet of flow charts, mother's counselling booklet, labour form, referral form. maternal and newborn home record, wall chmis, adaptation and training guides. and technical basis papers.
2.1.6 Managing complications in pregnancy and childbirth
Dr Richard Guidotti introduced the manual which WHO has developed for physicians and midwives working in the district hospitals. The manual, using a symptom-based approach to diagnosis, included normal childbirth and only the emergency and serious complications of pregnancy and childbirth which will be very useful for the health staff in referral hospitals. ·r he use of this man11al creates a good linkage with the primary level health care and thus becomes an essential component of IMPAC Aside for the clinical management of cases, it also included sections on emotional support. The recommendations provided were based on available evidence from the review of studies. Dr Guidotti explained that this could be used in setting standards of care or revising current obstetric practice but some countries may need to translate and adapt it prior to nationwide use.
2.1.7 Integrating the safe motherhood in health system reform
Dr Hematram Yadav, the WHO consultant to the workshop, presented the main reforms needed in the health care system of the countries to improve maternal mortality. I le emphasized the need to have clear goals and objectives for reproductive health and more resources tor maternal and child health care. The reforms needed were mainly to improve accessibility and availability of services for maternal and child health, upgrading the health centres for maternal and child health services, doing maternal mortality audit, and integration of maternal and child health/family planning. It is important that the budget allocation for maternal and child health should be proportional to the size of the problem in the respective countries. Although increasing the antenatal coverage is important in some countries, the quality of the antenatal care and postpartum care is equally important and has to be addressed. Finally, it is impmtant that all available resources at the country level are utilized, including community participation.
2.1.8 Safe motherhood and community participation
The Philippine participants presented "Functional two-way community-based referral system: A partnership approach to safe motherhood". In this approach, there is a two-way referral system for obstetric emergencies from the household level up to the highest level of care. Health care is not the responsibility of the midwife but also of the community. The community should get involved in the management of health services. The three levels of care identified are the rural health unit, the community and the hospitals. In this project, the community takes
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responsibility for the health care of the people; however, the project needs to be followed up and sustained.
Another project involving the community was presented by the Papua New Guinea participants and in that project doctors travel to remote villages to see and treat patients. Some of the villages do not have access to medical care, so this approach helps to reduce the burden of disease in the community.
2.1.9 Political commitment to safe motherhood
The participants from the People's Republic of China presented "Political commitment to
Sat~ Motherhood in China". The Ministry of Health in China has been continuously monitoring China's maternal mortality rates since 1990. The national maternal and child health surveillance office is responsible for data collection, analysis, and quality control of this project. It covers a total of 116 surveillance sites across the country including 37 urban districts and 79 counties. The strategy to monitor maternal mortality has shown reduction in the maternal mortality since
1990 although large discrepancies exist between different regions in China. The coastal regions
have the lowest MMR and remote areas have higher MMR. In order to bridge the gap between
the poor regions in western China and the coastal regions, the government of China has formulated a strategy which integrates health development as its major component to develop the western part of the country. The key strategies are to increase hospital deliveries and strengthen the capacity of health faci I ities at the grassroots level to deliver obstetric care.
The participants of VietNam also explained how VietNam was politically committed to safe motherhood. They explained the various decisions and laws made by the Minister of Health and the Prime Minister which were related to sate motherhood. They also showed indirect relationship between facility-based childbirth and maternal mortality ratio.
2.1.1 0 Building partnership and resource mobilization
In this session WHO, UNICEF, UNFPA, and ADB spoke on their roles and how they function at the country level. The WHO representative explained the budget process. The overall
budget for the Region was 788 mi II ion for the 1998/99 bienni Llll1 . The majority of the funds came from governments (459.9 million); other lJN agencies gave 90.8 million. Overall, the funds for
the Region are decreasing.
UNICEF works very closely with a variety of partners at national and local levels. There is less hureaucracy in UNICEF and funds can be requested directly at the country level. UNICEF
officers can monitor projects at even the village level.
UN FPA, on the other hand, is the largest internationally funded source of population assistance to developing countries . Its main objective is to provide developing countries quality reproductive health and family planning services, to advance the strategy of !CPO and ICPD+5
and to promote cooperation among UN agencies. The three main programmes are Reproductive
Health/Family Planning Population and Development Strategies and Advocacy.
The Regional Technical Assistance Project (RET A) is the strengthening sate motherhood programme conducted by ADB/UNICEF. The main objective of RET A is to improve maternal
health and reduce maternal mortality by about half over the next decade. Six countries are covered by the project in Asia and the countries in the Western Pacific Region are Cambodia, Lao
People's Democratic Republic and Papua New Guinea.
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Country perspectives on how international agencies and nongovernmental organizations function at the country level were given by Cambodia and the Lao People's Democratic Republic. Jn their presentations, the speakers focused on the need for better coordination at the country level between various agencies. There are several programmes which are not coordinated and they overlap. The programmes last for only a year or two and then due to lack of funds are stopped. To overcome the problem of overlapping among agencies. most of the countries have now formed a committee at the country level to coordinate the various projects and activities.
2.2 Summary of country reports
All the countries represented presented their country reports and the summary of the country reports is given below. (Also see Annex 4).
Cambodia is one of the poorest countries in the Region and its current population is 1 I .4 million. Eighty five percent of this population is rural and females constitute 52% ofthe population. A total of 42% of the young population is under I 5 years of age. Females aged 15-44 years constitute 24 .9% of the population. Crude birth rate is 3.8% and total fertility rate is 5.2 ( 1997). Only 12~/o of Cambodian women have secondary or higher education, and 14% have primary school education. The low level of female education results in a lack of general knowledge and affects common behaviour. The maternal mortality ratio is 473 per I 00 000 live births ( 1995). infant mortality rate is 80 per I 000 live bit1hs and the contraceptive prevalence rate is I 6%. Only 45% of pregnant women attend antenatal clinic and 30% receive two tetanus toxoid immunizations. Only 5% of births take place in the institutions and 70% of births are not reported to the health care system. The main causes of maternal rnortal ity are postpartum haemorrhage. eclampsia, obstructed labour and sepsis. The factors influencing maternal mortality are poverty. largeness of family. low education, and poor information available on maternal mortality.
The Government of Cambodia gives high priority to the safe motherhood programme. The main focus of the safe motherhood policy is improving maternity care services. child spacing at all levels of health care delivery and reducing the rate of abortions. In this respect several protocols and guidelines have been developed and several ofthe activities of the safe motherhood programme are supported by several international agencies. Further key interventions include among others the use of traditional bitih attendants for normal deliveries in remote areas. The Ministry of Health encourages families to seek appropriate and timely health care and registration of all births and deaths.
The Peoples Republic of China has a population of I 284 million (1998) and the female population constitutes 603 million or 46.9%. The health budget represents 2.27% of the national expenditure. Maternal mortality ratio is 56.2 per lOO 000 live births (1998), infant mortality rate is 33.2 per 1000 live births and under 5 mottality is 42 per 1000 live births. The main causes of maternal mortality are obstetric haemorrhage (54. 16% ), PI H syndrome (12.28% ), puerperal infection (5.16 %) and clinical complications (2 I .22%). The national policy on maternal mortality is to reduce MMR by 50% by 2000 based on the level of 1990. There has been a significant reduction in maternal mortality and infant mortality in China since 1990. However, there is a large disparity between different regions. The coastal regions have a lower mortality rate and remote areas have a higher mortality rate. There is a high illiteracy rate in poor and remote areas, which hinders the improvement of women's health. The incidence ofSTIIHIV and AIDS is increasing and the maternal health of migrant population needs to be addressed.
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The Lao People's Democratic Republic has a population of 4.57 million and over 80% of the population lives in rural areas. The maternal mortality ratio is 650 per 100 000 live births and the infant mortality is 104 per 1000 live births. About 56% ofthe females are enrolled in primary schools and the adult female literacy rate is 47%. The contraceptive prevalence rate is 25%. The main causes of maternal mortality are postpartum haemorrhage, retained placenta, eclampsia, obstructed labour, sepsis, induced abortion, and uterine inertia. About 28% of deaths occur during pregnancy and 72% occur after delivery. More than 73% are due to direct obstetric cause and most of them due to postpartum haemorrhage. Most of the deaths occur at home (90%) and the number of institutional deliveries is low. Most of the contributing factors are early pregnancy, poor nutrition, high fertility rate, low literacy, severe anaemia, malaria, and poor availability and accessibility of health care. The national policy on Maternal and Child Health is addressing these issues, a national workplan on safe motherhood for year 1998-2002 has been developed and the objective is to reduce MMR from 6501100 000 live births to 400/100 000 by year 2002. Similar objectives have been set for infant mortality and under 5 mortality in China. Among other activities to reduce MMR are improving access, community participation, integrating maternal and child health/family planning, coordinating with international agencies and strenb>thening reproductive health.
Mongolia has a population of2.4 million and has a density of 1.4 persons per square kilometre. It is a vast country with a sparse population and poor communications system. The crude birth rate was 21 per 1000 live births in 1999 and life expectancy is 67.9 years. The maternal mortality ratio is 175 per 100 000, the infant mortality is 36 per 1000 live births and the contraceptive prevalence rate is (CPR) is 50.3%. The most common form of contraception is the intra-uterine contraceptive device (IUCD). About 3.8% of the GNP is spent on health. The total fertility rate is 2.3 and it is decreasing. The main causes of MMR are postpartum haemorrhage (I 1.2%), PET/eclampsia (24.4%), sepsis (I 0.1 %), obstructed labour ( 4.4%) haemorrhage during pregnancy (5.5%) and the indirect cause is 44.4%. Mongolia adopted a population policy only in 1996. The government has introduced the National Programme to Improve Women's Status, Reproductive Health National Programme and the National Adolescent programme. The main problems of maternal mortality are poor quality of antenatal care, poor knowledge, lack of essential drugs and equipment. poor referral system and poor communication system in the whole country. The government has taken serious steps to reduce these problems. International agencies also have several programmes to overcome the reproductive health in the country.
Papua New Guinea has a population of 4.7 million and about 700 languages. The crude bi1th rate is 33 per 1000 live births and the crude death rate is I 0 per I 000 live births. The maternal mortality ratio is 370 per 100 000 live births, the infant mortality is 77 per 1000 live bi1ths and the total fertility rate is 4.8. The contraceptive prevalence rate is 26%. The main causes of maternal mortality are postpartum haemorrhage (30%), sepsis (28%), malaria and anaemia (15%) obstructed labour (4%) and PET/eclampsia (3%). The main issues are poor infrastructure, geographical isolation and inaccessibility, shortage of trained manpower, inappropriate use of available funds, inadequate transport facilities, and staff motivation and commitment. To overcome these problems, the government is trying to improve the health of women by trying to increase antenatal coverage for women. It is also increasing the contraceptive rate through a vasectomy programme. The use of radio to educate mothers is another means to improve knowledge among the women.
The Philippines is an archipelago with 7 100 islands and has a population of74 million. The life expectancy is 71 years tor females and 66 years for males. The MMR is 172 per I 00 000 live bi11hs (NDHS 1998). MMR has a wide variation in the country with low in Manila and high in the Autonomous Region of Muslim Mindanao (ARMM) which has an MMR of 320 per
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100 000. The infant mortality is 36 per I 000 I ive births, the perinatalmortality rate is 27 per 1000 live births. About 65% of the deliveries areal home, only 34.2% are in health facilities. Overall, about 41% of the deliveries are still conducted by traditional birth attendants and the rest by doctors and nurses. The main problems of reducing maternal mortality are lack of funds, strong religious beliefs, and poor distribution of resources especially doctors, and delay in seeking health care in the remote areas, unavailability of quality services in the islands and, finally, poor collaboration with the private and professional societies. To overcome these differences, the First National Motherhood Conference was held in Davao City in August 1999 to develop a framework to reduce maternal mortality. The following principles were formulated: promotion of women's rights, access to quality health, focusing on health promotion and advocacy, addressing family planning issues, empowering communities and repmiing all maternal deaths. Other strategies include prevention and treatment of anaemia, and clean and safe deliveries. The country has also several ongoing programmes with international agencies in several provinces and more needs to be done in high priority areas.
VietNam has a population of 76 million and about 38.8 million are females. It is a young population and 33.5% of the population is below 15 years of age. The GOP per capita is US$352 and 3.8% ofthe national budget is spent on health. The MMR is 100 per 100 000 live births the infant mortality is 36.7 per I 000 1 ive births, contraceptive prevalence rate is 62. 1% and the total fertility rate is 2. 5. The major causes of MMR are haemorrhage (70% ), infection ( 14% ), PET/eclampsia (I 0% ), and uterine rupture (2% ). The main problems are lack of trained midwives, (approximately 40% ofthe CHC are without midwives). lack of knowledge and training of the existing staff, inadequate drugs and equipment, poor community involvement. low budget and poor communication. The government has taken serious steps to reduce this problem by making decrees and laws to protect the society. The national policy on sale motherhood is to improve the health of the mother and newborn and to reduce MMR to 70 per I 00 000 live births by 2010 and lMR to 25 per I 000 in the same period. The strategy includes providing essential obstetric care and antenatal care. providing essential drugs, providing clean delivery kit, and home delivery to be attended by a trained health worker. improvement of training of personnel, and transportation. Several international agencies have projects in various provinces throughout the country.
2.3 Summary of discussions
There was active discussion in the workshop and the summary of the discussion and is'iues are as follows:
2.3.1 There is poor registration ofbi1ihs and deaths in many of the participating countries. Efforts should be made to improve the data collection and analysis. The public should be encouraged to register all births and deaths. This will help to improve the health information and statistics.
2.3.2 Although hospital deliveries are being encouraged in some countries to reduce maternal mortality, they may not be applicable to all countries because of limited resources. The increased hospital deliveries will increase utilization rate in hospitals and this will also increase the cost of health care. Countries should review their own situation and make their decisions.
2.3.3 The use of traditional birth attendants is also dependent on individual countries. Efforts should be made to increase safe delivery by trained personnel at home or in institutions. If there are limited resources and transportation is a problem, especially in remote areas, the use of
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available resources like traditional birth attendants or village health workers should be considered.
2.3.4 Some of the countries are in the process of introducing national health care insurance
schemes. This may affect the accessibility of care for maternal and child health services.
Countries should make available resources to make sure that maternal and child health care is not
affected.
2.3.5 There are too many international agencies and nongovernmental organizations in
different provinces in the countries and some of the strategies applied vary in the training and
implementation. There are no resources for sustaining these programmes. Both the country
representatives and the agencies should try to work out the problem of sustaining the strategy.
2.3.6 There are several guidelines available in the countries. Some of them developed by
international agencies and some by the country personnel. An effort should be made to
standardize these guidelines so that the training can be standardized in these countries.
Agreement for use ofiMPAC and manual :
2.3. 7 The programmes discussed in this workshop are not vertical programmes and have to be
coordinated in the existing MCH programme.
2.3.8 Networking to exchange information and experiences should be encouraged between
the countries to help each other to reduce maternal mo1tality.
2 .3.9 The plans of action prepared in this workshop should be tinalized and countries should
work with international partner agencies for strategies planned.
2.4 Evaluation ofthe workshop
Twenty-nine representatives from seven countries attended the workshop and all or them
said that the objectives of the workshop were met. Overall the process and outcome were
well-received. Few participants observed that the discussion period during tile workshop \Vas
sho11 and should have been lengthened so that the participants could exchange ideas during the
discussions. One pa11icipant wanted the reading materials to be available earlier so that we could
have a better discussion. Most of them are willing to take part in the network . There was a
request to have the next meeting in a province so that we can see field experience.
3. CONCLUSIONS
The participants affirmed that it is the right of every mother and infant to survive
pregnancy and childbirth and that each maternal death is both a failure and a tragedy. The
pa11icipants believe that protecting women and mothers is the responsibility and duty of each
family, each community and each local and national government and the participatJts conclude
that:
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1. Maternal mortality ratio (MMR) and neonatal mo11ality rate (NMR) are still unacceptably
high in some countries in the Western Pacific Region and there is an urgent need for
governments to undertake more pro-active steps to reduce these high levels.
2. Seven WHO Member States have developed draft national action plans on safe
motherhood which are intended to guide their respective national programmes to reduce
maternal morbidity and mortality.
3. The draft action plans attempted to identify possible sources of investments to implement
programmes for the years 2000 to 2005. It is recognized that there is a need to further
strengthen partner agencies' collaboration to rationalize use of resources to be able to provide
maximum support to the national plans and programmes for safe motherhood and maternal
mortality reduction.
4. The participants will mobilize political support to implement the national action plans as
soon as possible. In addition, building capacities of countries to plan, manage, implement and
monitor safe motherhood programmes need to be developed and strengthened.
5. Country officials, the donor community, and other stakeholders will continue to
recognize the national action plan as a vital component to make pregnancy safer . The national
action plan is a dynamic instrument that will continue to evolve to become an even more
realistic reflection of a country's thrusts and priorities to reduce maternal morbidity and
mortality.
6. The WHO standards of care guidelines (Essential Care Practice Guides and Managing
Complications of Pregnancy and Childbirth) are available and may be adapted and used by
countries according to their specific needs, priorities and resources.
7. MMR is an impact indicator which reflects a woman's basic heath status, her access to
health care and the quality of care that she receives. However, there are times when MMR
may be difficult to measure and it may not adequately reflect trends in maternal health.
Countries may utilize other process indicators to monitor their safe motherhood programmes
such as proportion of pregnancies and deliveries attended by skilled attendants; health facilities
delivery rate; number of facilities with functioning basic essential obstetric care; proportion of
pregnant women with tetanus toxoid immunization and others, as necessary.
8. A network on maternal and newborn health among the participating countries, the UN
agencies, and other international organizations represented in the workshop has been organized
and will be made operational as soon as possible.
9. The network is established to ensure the continuous coordination and collaboration
among the Member States and ensure opportunities for region-wide dissemination of
information. Specifically, it is expected that the network will promote and facilitate
information sharing; facilitate collaboration and coordination for promoting safe motherhood
and making pregnancy safer; provide support in programme monitoring and evaluation; and
facilitate and assist Member States in mobilizing resources for strengthening safe motherhood
programmes.
- 12-
10. Member States in the Region will continue to collaborate and help one another to reduce
maternal and neonatal deaths and WHO will continue to be the lead agency in technical and
collaborative activities in making pregnancy safer.
CAMBODIA
CHINA
- 13 -
LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISERS, RESOURCE PERSONS,
REPRESENTATIVES, OBSERVERS AND SECRETARIAT
1. PARTICIPANTS
Professor Eng Huot Director-General of Health Ministry of Health I 5 I ·· I 53 Kampuchea Krom A venue Phnom Penh Telephone no .: Fax no.: E-mail:
(855 023) 880 406/016 813 151 (855 029) 880 407 [email protected]
Dr Tan Vuoch Chheng Deputy Director National Maternal and Child Health Centre P.O. Box I 13, St . France, Sras Chak Phnom Penh Telephone no. : Fax no.:
Dr Chhun Long
(855 23) 015 917 951 (855 23) 023 362 516
National Programme Manager for Reproductive Health National Maternal and Child Health Centre P.O. Box I 13, St . France, Sras Chak Phnom Penh Telephone no.: Fax no.: E-mail:
(855 23) 362516 or (855 23) 427300 (855 23) 430142 [email protected]
Mr Guo Shenggui Deputy Director General PHC/MCH Department Ministry of Health Beijing, Telephone no .: (8610) 6879 2303 Fax no.: (8610) 6879 2321
Dr Wan Yan Division Chief National Working Committee for Children and Women Beijing, Telephone no. : Fax no.: E-mail:
(861 0) 65 22 5324 (8610)6513 3997 hdha@public3. bta.net.cn
ANNEX I
Annex I
LAO PEOPLE'S DEMOCRATIC REPUBLIC
- 14-
Dr Xing Jun Project Officer PHC/MCH Department Ministry of Health I Xizhimenwai Nanlu Beijing I 00044 Telephone no.: Fax no.: E-mail:
(8610) 6879 2310 (861 0) 6879 2321 [email protected]
Dr Huang Xinghua Professor of Obstetrics and Gynaecology Beijing Obstetrics and Gynaecology Hospital 17 Qihelou Beijing 100006 Telephone no.: (86 10) 6525 0731 Fax no.: (8610) 6595 8095
Dr Zhao Gengli Associate Professor Mother and Infant Health Care Center Beijing Medical University I X ian men Street I 00034 Beijing Telephone no.: Fax no.: E-mail:
(861 0) 6617 4284 (8610) 6616 7629 gengli [email protected]
Dr Douangchanh Keoasa Deputy Director Department of Hygiene and Prevention Ministry of Health Vientiane Telephone no.: ( 856) 21 2140 I 0 Faxno. : (856)21214010
Dr Khanthong Siharath Deputy National Project Director, Reproductive Health/
Family Planning and Chief of Training Division Maternal and Child Health Center Ministry of Health Vientiane Telephone no.: (856) 21 214596 Fax no.: (856) 21 214595
Dr Chansouk Chanthapadith Chief of Technical and Evaluation Section and Coordinator of EPIO; Logistic of Reproductive Health Programme of
Maternal and Child Health Center Maternal and Child Health Center Ministry of Health Vientiane Telephone no.: Fax no.: E-mail:
(856) 21 214596 (856) 212 14595 Lao net_ net _gtzhp@lao net. net
MONGOLIA
PAPUA NEW GUINEA
- 15 -
Dr Darjaa Oyunsuren Director. Public Health Department Dalanzadgad Town South Gobi Aimag Province Telephone no.: (976) 1 053 3719
Dr Seded Khishgee Deputy Director Maternal and Child Health Research Centre Bayangol District 15 Ulaanbaatar-24 Telephone no.: (976) I 362951 Email: khishgee [email protected]
Dr Ishnayam Davaadorj Senior Officer, Reproductive Health Coordination and Policy Development and National Programme Director Reproductive Health Subprogramme, UNFPA Ministry of Health and Social Welfare Ulaanbaatar-24 Telephone no.: Fax no.: E-mail:
(976) 1 322878 (976) I 311601 [email protected]
Dr Genden Purevsuren Logistics and Training Consultant Reproductive Health UNFPA Sub-Programme P.O. Box 29/645 Ulaanbaatar Telephone and Fax no.: E-mail:
(976) 1 3 II 60 I [email protected]
Dr Mathias Sapuri Acting Dean Medical School University of Papua New Guinea Box 1774 Boroko, N.C.D. Telephone no.: Fax no.: E-mail:
Dr Ligo Augerea Obstetrician
(675) 3112626 or 3112504 (675) 3230066 [email protected] .pg
Alotau Hospital Milne Bay Province Telephone no.: (675) 6411200 Fax no.: (675) 6410040 E-mail: [email protected]
Annex I
Annex 1
PHILIPPINES
VIETNAM
- 16-
Dr Shirley Heywood Obstetrician/Lecturer Division of Obstetrics and Gynaecology University of Papua New Guinea Boroko, N .C.D. Telephone no.: Fax no. : E-mail:
(675) 323 2411 (675) 323 2411 [email protected]
Dr Paulyn Jean Rosell-Ubial Officer-in Charge Maternal and Child Health Service/Family Planning Service 2"d floor, Building 13 Department of Health Compound Sta. Cruz, Manila Telephone no.: (63 2) 658 5386 Fax no.: (632) 752 9961 E-mail: [email protected]
Dr Carmen C . Gervacio Medical Officer VII Maternal and Child Health Service/Family Planning Service 2"d floor, Building 13 Department of Health Compound Sta. Cruz, Manila Telephone no.: (63 2) 931 4979 Fax no .: (63 2) 732 9961 E-mail : [email protected]
Ms Vicenta E. Borja Nurse VI Maternal and Child Health Service/Family Planning Service 2"d floor, Building 13 Department of Health Compound Sta. Cruz, Manila Telephone no.: (63 2) 446 2563 Fax no.: (632) 732 9961 E-mail : [email protected]
Professor Tran Thi Phuong Mai Deputy Director Department of Maternal and Child Health/Family Planning
Ministry of Health 138 A Giang Vo Street HaNoi Telephone no.: Fax no.:
Dr Vu Thi Thanh
(84 4) 8329119 (84 4) 8236926
Senior Programme Officer Department of Maternal and Child Health/Family Planning
Ministry of Health 138 A Giang Vo Street HaNoi Telephone no.: Fax no. :
( 84 4) 8464060 (84 4) 8430487
- 17 -
Dr Truong Thi Thu Van Department of Obstetrics and Gynaecology Bach Mai Hospital No. 20, 81 A Klmuen Quarter HaNoi Telephone no.: (84 4) 8522401
Dr Nguyen Due Vy Director National Institute for Protection of Mothers and Newborn c/o UNICEF !VietNam 72 Ly Thuong Kiet Street HaNoi Fax no.: (84 4) 826 2641
Ms Mai Thi Cong Danh Researcher, Management System and Scientific Researcher on Obstetrics/Gynaecology Tu Du Obstetric Hospital 24 An Duong Vuong Street Ho Chi Minh City Telephone no.: (84 08) 320 391
2. CONSULTANT
Dr Hematram Yadav Associate Professor Department of Social and Preventive Medicine University of Malaya Kuala Lumpur Malaysia Telephone no.: Fax no.: E-mail:
(60 3) 736 8081 (60 3) 252 5579 [email protected]
3. TEMPORARY ADVISERS
Dr Glen Mola Associate Professor and Head Obstetrics and Gynaecology University of Papua New Guinea Box 1421 Boroko NCO Papua New Guinea Telephone no.: (675) 324-83 I 0 Fax no.: (675) 375 82 I 2 E-mail: [email protected]
Annex 1
Annex 1
UNFPA
- 18-
Dr Loreto Mendoza Independent Consultant Primary Health Care/Maternal and Child Health
No. 23 Charming Street BF Homes, Almanza Las Pinas Philippines Telephone no. : (63 2) 806 1760
E-mail: [email protected]
4. RESOURCE PERSONS
Mr WuGuogao External Relations Officer
World Health Organization
Regional Office for the Western Pacific
Manila Philippines Telephone no. : Fax no.: E-mail :
(63 2) 528 9930 (direct) (632) 521-1 036; 526-0362; 526-0279
Mr D. Bayarsaikhan Technical Officer, Health Care Financing
World Health Organization
Regional Office for the Western Pacific
Manila Philippines Telephone no.: Fax no.: E-mail :
(63 2) 528 9808(direct) (632) 521-1036; 526-0362; 526-0279
5. REPRESENTATIVES
Ms Florence Tayson Assistant Representative
United Nations Population Fund
NEDA sa Makati Building I 06 Amorsolo Street, Legaspi Village
1229 Makati City Philippines Telephone no. : Fax no.: E-mail :
(63 2) 892 06 11 to 25 (63 2) 8178616 [email protected]
UNICEF
- 19-
Dr Liu Bing Project Officer for Maternal and Child Health UNICEF Area Office for China and Mongolia 12 Sanlitun Lu Beijing 100600 China Telephone no.: (861 0) 6532 3131 Fax no.: (8610) 6532 3107 E-mail: [email protected]
Dr Martha B. Cayad-an Maternal Health and Nutrition Officer UNICEF/Manila 61
h Floor, NEDA sa Makati Building I 06 Amorsolo Street, Legaspi Village 1229 Makati City Philippines Telephone no.: Fax no.: E-mail:
(63 2) 892 7653 (632) 810 1453/810 0272 [email protected]
Dr Onevanh Phiahouaphanh Programme Officer, Community Health UNICEF Vientiane Telephone no.: Fax no.: E-mail:
(856) 21 315 200 (856) 21 314 852 [email protected]
Dr Ketsamay Rajphangthong
Annex 1
Assistant Programme Officer, Maternal Health/I-Iealth Promotion UNICEF Vientiane Telephone no.: Fax no.: E-mail:
(856-21) 315 200 (856) 21 314 852 [email protected]
Ms Tytti Karppinen Assistant Programme Officer, Health Education/Health Information UNICEF Vientiane
· Telephone. no.: Fax no.: E-mail:
(856) 21 315 200 (856) 21 314 852 [email protected]
Annex 1
ASIAN DEVELOPMENT BANK
- 20-
6. OBSERVERS
Dr Kus Hardianti Health Specialist, Education Health and Population Division (East) Asian Development Bank 6, ADB A venue Mandaluyong City Philippines Telephone no.: (63 2) 632 444 Fax no.: (632) 636 444 E-mail: [email protected] Dr Vincent de Wit Health Specialist Regional Technical Assistant Project for Safe Motherhood
Asian Development Bank 6, ADB A venue Mandaluyong City Philippines Telephone no. : Fax no. : E-mail:
Mr Jeffrey Sine
(63 2) 632 5732 (632) 636 2310 [email protected]
Consultant, Strengthening Safe Motherhood Programmes The Futures Group International 1050 17'" Street, N.W. Suite 1000 Washington, D.C. 20036 United States of America Telephone no.: 1-202) 775 9680 Fax no.: (I 202) 775 9694 E-mail: [email protected]
Ms Nancy Piet-Pelon Consultant, Strengthening Safe Motherhood Programmes The Futures Group International 1050 17'" Street, N.W. Suite 1000 Washington, D.C. 20036 United States of America Telephoneno. : 1703)3712621 Fax no.: (1703) 575 9650 E-mail: [email protected]
- 21 -
7. SECRETARIAT
Dr Pang Ruyan (Responsible Officer) Regional Adviser in Reproductive Health World Health Organization Regional Office for the Western Pacific Manila Philippines Telephone no.: Fax no.: E-mail:
(63 2) 528-800 I; 528-9876 (direct) (632)5211036 [email protected]
Dr Rebecca Ramos Short-term Professional in Reproductive Health World Health Organization Regional Office for the Western Pacific Manila Philippines Telephone no.: Fax no.: E-mail:
(63 2) 528-8001; 528-9878 (direct) (63 2) 521 1036 [email protected]
Dr Richard Guidotti Medical Officer, Reproductive Health and Research World Health Organization CH-1211 Geneva 27 Switzerland Telephone no.: Fax no.: E-mail:
( 41 22) 791 2111 (41 22)791 4189 [email protected]
Dr Omelia Lincetto Medical Officer, Reproductive Health and Research World Health Organization CH-1211 Geneva 27 Switzerland Telephone no.: Fax no.: E-mail:
(41 22)791 2111 (41 22)791 4189 [email protected]
Dr Jaime Galvez Tan President FriendlyCare Foundation, Inc. (Regional Technical Assistance, Safe Motherhood Programs UNICEF East Asia and Pacific Regional Office) Ortigas Centre Pasig City 1605 Philippines Telephone no. Fax no.: E-mail:
(632) 637 0470 (632) 637 3064 [email protected] [email protected]
Annex 1
Annex 1
-22-
Dr Nikki R. Lambo Affiliation Director FriendlyCare Foundation, Inc. (Regional Technical Assistance, Safe Motherhood Programs UNICEF East Asia and Pacific Regional Office) Ortigas Centre Pasig City 1605 Philippines Telephone no.: Fax no.: E-mail:
Dr Ray Y.iQ
(632) 636 2790 (632) 635 4719 [email protected] [email protected]
Senior Project Officer for Health and Nutrition UNICEF Area Office for China and Mongolia 12 Sanlitun Lu Beijing I 00600 China Telephone no.: Fax no.: E-mail:
Ms Agnes Jacobs Nurse Educator
(8610) 6532 3131 ext 133 (8610) 6532 3107 [email protected]
Word Health Organization House 120, Street 228 Sankat Chadomuk Khan Daun Penh Phnom Penh Cambodia Telephone no.: Fax no.: E-mail:
(855) 23 216211 (855) 23216942 [email protected]
Dr Jayanti Man Tuladhar Adviser, Reproductive Health/Family Planning/MIS/Logistics UNFPA Country Support Team Office for East and South-East Asia GPO Box 618 Bangkok 10501 Thailand Telephone no.: Fax no.: E-mail:
(662) 288 2450 (662) 280 2715 [email protected] [email protected]
- 23-
ANNEX 2
WORKSHOP ON MATERNAL MORTALITY REDUCTION IN SELECTED COUNTRIES IN THE WESTERN PACIFIC REGION
29 May- 2 June 2000, Manila, Philippines
PROVISIONAL AGENDA
I. Opening ceremony
2. Orientation to the workshop
3. Introduction ofthe regional strategic plan on maternal mortality reduction
4. Introduction of the global movement on Making Pregnancy Safer Initiative
5. Implementing IMPAC and adapting the Emergency Obstetric Case Management Manual
6. Integrating safe motherhood programme into health systems reform and human resource development
7. Political commitments on Safe Motherhood programme and community participation
8. Building partnerships
9. Country reports
I 0. Group discussions (e.g. establish a regional network on maternal mortality reduction)
II. Presentation of draft national working plans by country teams
12. Closing ceremony
-24-
-25-
ANNEX 3
OPENING REMARKS BY DR SHIGERU OMI, REGIONAL DIRECTOR, AT THE WORKSHOP ON MATERNAL MORTALITY REDUCTION IN
SELECTED COUNTRIES IN THE WESTERN PACIFIC REGION, MANILA, 29 MAY - 2 JUNE 2000
DISTINGUISHED PARTICIPANTS, COLLEAGUES, LADIES AND GENTLEMEN:
1 am very pleased to welcome you to Manila and to the WHO/WPRO for this important consultative workshop on maternal mortality reduction. It is significant that UNICEF has decided to join us and be a co-sponsor of the meeting. I am pleased to note that UNFPA and the Asian Development Bank are also very well represented.
We have called this consultation to determine what we can do together to address the global issue of unacceptably high maternal mortality especially in our Region where about 50 000 maternal deaths occur yearly. This is an old problem. But what we need to do now is to determine why progress in the reduction in maternal mortality ratio is slow in some countries and how this can be remedied.
Maternal mortality ratio is an impact indicator which reflects a woman's basic health status, her access to health care and the quality of care that she receives. WHO and UNICEF have referred to the indicator as "a litmus test ofthe status of women". It cuts across different sectors and is affected by multiple factors including socio-economic considerations. While some aspects are difficult to resolve, we, in the health sector, should do our utmost to plan and implement programmes in a most effective and efficient way.
For the past ten years, programmes to improve maternal health have been implemented. Experience has shown what works and what does not in safe motherhood programmes. For example, training of traditional birth attendants and community-based health workers alone will not significantly contribute to reduction of maternal deaths. These workers can be trained to handle normal aseptic delivery only and not emergency obstetrics. Therefore, we may have to rethink the projects that we have been developing along this line. In the past, more resources were earmarked for antenatal care than for delivery, immediate postpartum care and emergency obstetric care. But now we know that the vast majority of complications occur during and after delivery and in the first hours and days after delivery. These and other important lessons learned should be the basis of our current and future planning.
While we have been concentrating on the highly technical and medical aspects, the economic, political and health systems issues should not be lost sight of. National governments must acknowledge that safe motherhood is a cost-effective economic and social investment. We, therefore, urge them to allocate resources and invest an appropriate intervention for implementation. Political commitment needs to be translated into action. This is the reason why we have requested that government decision makers attend this consultation.
Now, I understand that during this consultation, you will be sharing your experiences in implementing safe motherhood programmes. You will also discuss strategies to reduce maternal mortality, and prepare work plans.
-26-
Annex 3
I propose that you take stock of the strengths and comparative advantages of certain
country programmes and identify the contributions or role of each key player, from the
government to the international partner agencies.
With the participation of government decision makers and experts who are familiar with
the country situations, we can determine the more urgent needs that require our attention. The
involvement of key partner agencies will greatly enhance this planning process. Programme or
resource gaps can be identified together and therefore areas of collaboration can be clearly
defined thus lessening expensive duplications and overlaps.
We all share the same goal of having healthier mothers and children. This common goal
should guide us in looking at ways by which we could complement each other's efforts.
For the next five days I expect a lot of intense discussions among country participants as
well as with partner agencies. With your commitment and perseverance I have no doubt this will
be a productive consultation.
Thank you and good day.
WORKSHOP ON MATERNAL MORTALITY REDUCTION ACTION PLAN FOR SAFE MOTHERHOOD 2000- 2005
CAMBODIA
Overall Goals: To make pregnancy safer and to improve pregnancy outcomes for women in Cambodia, by:
1. Reducing the number of women suffering pregnancy-related morbidity and mortality in Cambodia by reducing maternal mortality ratio by 20% from
the baseline level (DHS 2000) by 2005. 2. Reducing the infant mortality rate from 80 per 1000 live births to 70 by 2005 .
3. Reducing the total fertility rate from 5.3 to 4.3 by 2005.
Issues/ Expected Time Responsible Performance Resource
Problems Objective Activities Results Frame Person Indicator Required Source
Reduce the number • Expand birth spacing services . I. CPR increases I. 2005 Birth Spacing
of unwanted - Expand availability of long-term to 30%. MOH
pregnancies. methods (IUD & sterilization). UNFPA
- Expand birth spacing service delivery 2. CPR for male RACHA
sites. sterilization 2. 2005 NGOs
• Inform families through mass education increases to 2%. Etc ....
campaign and inter-personnel communication for increasing demand. 3. Selected HCs IEC- MOH
providing IUD JICA insertions
3. 2005 4. IEC ..... ?
4.
Workshop on Maternal Mortality Reduction Action Plan for Safe Motherhood 2000 - 2005 Cambodia
Issues/ Problems Objective Activities
Reduce the • Expanded birth spacing services number of at risk • Increase coverage of ANC visits . pregnancies. • Increase the number of ANC visits per
pregnant woman.
Increase chances • Distribute iron/folic acid to all pregnant of surviving women. hemorrhage. • Add iron/folic acid tablet distribution to role
of TBA and/or to the role of other health workers.
• Train MWs and nurses in Life Saving Skills (LSS, or basic EmOC).
• Increase involvement oftrained birth attendants (MWs and nurses) in home deliveries. - Expand use of LSS, 3'd stage delivery
management.
• Develop mechanisms for linkages between midwives and TBAs.
• Distribute Mother's Health Records package to all health centers for use all pregnant women.
Reduce the delay • Increase attendance at births by more skilled in recognizing midwives and by more informed TBAs. delivery - Train TBAs to recognize delivery complications. complications and to direct complicated
cases to suitable facilities.
- Increase midwife's skills and involvement in home deliveries, through better TBA-midwife partnerships, increased demand for delivery by a midwife at local level.
Expected Time Responsible Results Frame Person
Performance Resource Indicator Required Source
N co
Workshop on Maternal Mortality Reduction Action Plan for Safe Motherhood 2000-2005 Cambodia
Issues/ Problems Objective Activities
• Phase in use of maternal deaths audits . And - Sustain audits where they are now conducted
(2 pilot areas). - Expand use in all referral hospitals - Institute use at community level where
feasible.
Reduce the delay • Conduct community IEC campaigns & in decision- advocacy campaign on early recognition of making to take delivery complications and importance of action in case of quick transportation of woman to a health delivery facility. complication. - Train HC midwives & TBAs in community
IEC. - Conduct mass education campaigns of
community through mass media and existing community structures.
- Conduct advocacy campaign with community/national leaders on MM issues.
Provide all • Train TBA in selected areas for nonnal women with delivery. access to clean • Expand use of3'd stage delivery using and safe oxytocin as a preventive intervention by delivery. trained attendants (MWs and nurses) .
• Increase the number of midwives trained and available for deployment to new facilities through regular midwifery training.
Expected Time Responsible Performance Resource Results Frame Person Indicator Required Source
Workshop on Maternal Mortality Reduction Action Plan for Safe Motherhood, 2000-2005 Cambodia
Issues/ Problems Objective Activities
Improve financial • Within the MOH's new user fee system,
and geographic implement fee exemption policies for poor
access to health care women needing EmOC. facilities for women • In selected areas, phase-in development of experiencing transportation arrangements for women in need pregnancy-related of referral to a HC or hospital for EmOC. complications. • In selected areas, phase-in establishment of LSS
(basic EmOC) for treating abortion complications and delivery complications at the peripheral (HC and home) level. - Expand use of oxytocins and anticonvulsants
in HCs and in the home by MWs and nurses. -Expand use of other life saving interventions at
HCs, including antibiotics, resusitation of neonates, and expansion of the MP A.
• Increase the number of midwives trained and available for deployment to new facilities through regular midwifery tra ining.
Improve quality of • Provide basic EmOC at selected HCs and
care for women improve quality of EmOC, including quality of
experiencing service providers, at all referral hospitals:
pregnancy-related -At HCs, management of hemorrhage,
complications. convulsions, administration of antibiotics, and
placenta removal. -At referral hospitals, all EmOC services
• In sequence: -Train existing midwives at existing health
centers in life saving skills. - Train other existing medical staff at existing
HC in life saving skills. Train staff at new health centers and referral hospitals as new facilities are established.
Expected Time Responsible Performance Resource
Results Frame Person Indicator Required Source
Workshop on Maternal Mortality Reduction Action Plan for Safe Motherhood 2000-2005 Cambodia
Issues/ Problems Objective Activities
-Increase the number of midwives trained and available for deployment to new facilities
Integrate basic • Establish a coordination mechanism with all EmOC into the related MOH departments and national MPA programmes. documentation and • Expand and modify MP A documents to include practice. prevention of complications and LSS (basic
EmOC) interventions.
• Phase in implement basic EmOC interventions from the MPA into practice.
• Get the Essential Drug Bureau and the Central Medical Store to supply equipment and drugs necessary for the added activities.
• Get the health information system to report details about pregnancy complications and maternal deaths.
Ensure integration • Map safe motherhood programs and services and of safe motherhood develop National Action Plan. components within - Make inventory of Safe Motherhood inputs existing MCH and into various MCH programs related programs -Conduct national workshops for review of the between the draft SM plan and dissemination of the final ministry of health plan. and other • Develop monitoring and evaluation plan for SM ministries, activities. international • Organize 3-monthly meetings with district organizations, management teams to monitor progress of SM bilateral agencies activities. and NGO's. • Publish annual statistics relative to indicators of
maternal health, BS, and newborn care.
Expected Time Responsible Performance Resource Results Frame Person Indicator Required Source
• Map • 2000 MOH, with • Short-term To be WHO
• Final support from consultant calculated RETA national WHO and develops map UNFPA plan RETA • National . Detailed workshop to imple- review draft mentation plan plans conducted
• National dissemination workshop conducted
Workshop on Maternal Mortality Reduction
Action Plan for Safe Motherhood 2000-2005
Cambodia
Issues/ Problems O bjective Activities
Develop • Develop and review nationally relevant
appropriate protocols for SM interventions using
policies and WHO and other guidelines.
regulations for - Translate and adapt WHO SM
specific, new areas guidelines. of safe motherhood • Using maternal death audit guidelines strategies. developed for the two pilot projects,
develop and implement national guidelines.
• Develop perinatal and neonatal death audit guidelines.
Conduct research • Develop a national research agenda for
that will be used to safe motherhood. create a better empirical base for policy making and program planning.
Expected Results
• All WHOSM guidelines translated.
• All existing SM guidelines reviewed.
• Final, revised national SM guidelines produced.
• National guidelines for MDAandNDA produced.
Time Responsible Frame Person
2000-2001 MOH; • CST/WHO
•
•
•
Performance Indicator
WHO guideline translation performed
CST advisor mission conducted National SM guideline document. National MDA andNDA guideline documents
Resource Required To be calculated
Source WHO
w N
Agency Programme/ Assisting Project Title
Government Reduction of of China MMR&NNTin
12 provinces
Support, WHO protection and
promotion of spontaneous delivery (research)
Safe Motherhood UNICEF Initiative
UNFPA Strengthening MCH/Family Planning Services at the Grassroots Levels
World Bank Health VI
WORKSHOP ON MATERNAL MORTALITY REDUCTION COUNTRY SITUATIONAL ANALYSIS
PEOPLE'S REPUBLIC OF CHINA
Activity Geographical Area Duration Funding Source
Training 12 provinces Jan. 2000-Dec. Central Government
Health education 378 counties 2001 Local Government
Equipment UNCEF
Monitoring & Supervision Poverty Alleviation Training 5 provinces Jan. 2000-Dec. WHO
Health education 2001
Control study
Training 3 1 provinces 1990-2000 UNCEF
Health education 468 counties GOC
Monitoring and Supervision Community Participation Training 23 provinces 1995-2000 UNFPA
Equipment 32 counties GOC
Surveillance Health Education Monitoring & Supervision Training 8 provinces 1995-2001 WB
Health Education 250 counties GOC
Equipment
Govt. Commitment
90%
Manpower
Matching fund Manpower
Matching fund Manpower
Matching fund Manpower
Issues/ Objectives Problems
Higher Reducing MMR in poor MMR areas
Poor Strengthening Ob/gyn ob/gyn service emergency capacity at treatment county &
skills of township county and levels township hospitals
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN
PEOPLE'S REPUBLIC OF CHINA
Activities Expected results Time frame Responsible Performance person indicator
Training MMR in poor areas 2000-2005 PHC/MCH Hospital
Poverty reduced by 20% of the Dept., MOH Delivery Rate
Alleviation 2000 level and ratio of
Health Education deliveries
Monitoring & attended by
Supervision skilled village
Equipment birth attendants
Training and Preventable deaths at 2000-2005 PHC/MCH Project counties
hands-on practice; the county and township Dept, MOH equipped with
Specially assigned levels reduced essential
experts; equipment for
Establishment of a emergency
referral system; treatment;
Provision of County and
essential township
equipment for hospital doctors
emergency trained
treatment
Resource Source required
US$ 300mil GOC, intemati onal agencies (UN and others)
US$ 200mil GOC ( 1.2/person) UN
& other intemati onal agencies
Issues/ Objectives Problems
Low utilization of health facilities
ANC 35%Delv To increase assisted by ANC cov to
HWI9% 60% by 2005
PCNJI%
Cpr 18%
A. Low To increase awareness of delv assisted communities in byHWto health 50% by2005
B. Low quality of MCHcare
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN 2000-2005
LAO PEOPLE'S DEMOCRATIC REPUBLIC
Strategies/Activities Expected results Time frame Responsible Performance person/ Indicator agency
I 2 3 4 5
I. Strenthening IEC on X X X X X MOHIMCH, # Health education
08 andECPG LWU,LYU session
I . Raising awareness Health education through health provider, sessions conducted mass media, community members, L WU, L YU
2. Organize Mother and Improve knowledge of X X X X X MOH/MCHI MCH examination
Child Health communities in health LWU,LYU days organized in all
Examination day (model care prov yearly
mothers and children)
3. Review/develop IEC Adequate IEC materials * MOHIMCH. IEC materials
materials and distribution and reach to people LWU.LYU available at health
to health facilities and facilities and villages
villages
4. Community Facilitate and stimulate * * * * * involvement through programme CMC implementation
II. Improvement health services at all levels in pilot area
I. National orientation Increased awareness on X MOH National orientation
workshop on MMR MMR reduction workshops conducted
reduction workplan.
Organize planning workshop in pilot area.
2. Develop of existing Improve the Qtl of Care X X WHO,MOH Manuals finalized.
manuals guideline on (especially EMOC) translated, pretested, IMPAC print and used
Resource required (US$) est
500 000
I 000 000
Source
UNICEF
UNICEF
WHO/UNC
EF/UNFPA
WHO/RET A
w U1
Workshop on Maternal Mortality Reduction
Summary of Action Plan 2000-2005 Lao People's Democratic Republic
Issues/ Objectives Strategies/ Activities
Problems
3. Operation manual of OB and ECPG for health facilities and village levels
3.1 Translation and discussion and finalize on OB and ECPG.
3.2 Printed manuals
4. Strengthening capacity of training centre in pilot area (TOT), training of care providers at provincial district health centre and VHW.
5. Provision of supplies/medical equipment to health service units
6. Improvement and expansion referral system in pilot area
7. Accurate health information system
Expected results Time frame
I 2 3 4
Knowledge and skill of X X X X HW improved and applied.
Adequate med sup! and X Qtl of service be improved
EOC be improved X X X X
Health data be improved X X X X in pilot areas
Responsible Performance Resource Source
person/ Indicator required
a2ency (US$) est
5
MCH
X MOHIMCH Training course conducted in two regional training
MOHIMCHC WHOIUNC WHO,
procured UNICEF. UNFPA
X MOHIMCHC Provide transportation, loan supported
X MOHIMCHC - Standardized WHO/
record forms UNICEF available and used
- Monitoring/supv/
mid-term review and evaluation conducted
Workshop on Maternal Mortality Reduction Summary of Action Plan 2000-2005 Lao People's Democratic Republic
Issues/ Objectives Strategies/ Activities
Problems
8. Monitoring/
supervision/evaluation
9. Annual review and planning workshop pilot areas in northern and southern parts of the country
REMARK: The project implementation, first pilot areas are 2 province, l 0 districts, 40 health centres and 80 villages in year 2001- 2002
the next, when success continue in 5 province, 30 district and 200 health centres and 120 villages in year 2003-2005
Expected results
Understanding and participation in implementation of MMr reduction programme
Time frame Responsible Performance Resource Source
person/ Indicator required a2ency (US$} est
I 2 3 4 5
X X X X X MOHIMCHC UNFPA/
UNICEF
X X MOHIMCH Conducted WHO/RET A
workshops
TOTAL I 500 000
Agency Programme/projec assisting t
Government Reproductive health
WHO MOG/RH-001
UNICEF Safe motherhood
UNFPA RH/sub-programme
WORKSHOP ON MATERNAL MORTALITY REDUCTION COUNTRY SITUATIONAL ANALYSIS
MONGOLIA
Major activities Geographical Amount and area Duration
- Management support through national All provinces 1997-2001 and provincial task forces established of Mongolia
- Delivery services to mother and child free of charge
- Provision of maternity leave (120 days before and after delivery)
- Re-establishment of maternity rest homes throughout the country
- Free delivery of emergency obstetrics and gynaecological aid
-Various technical support All provinces $145 000/
- Training of doctors on safe mother hood of Mongolia 2000-2001
and reproductive health services
- Supply of equipment
- Translation, printing and distribution of guidelines and manuals
- Local training on mobilization of National level $55 000-75 000 per community participation in safe year/ motherhood programme 2000-2001
- Translation and distribution of guidelines and training modules
- Management of sub-programme National level $2.3 million
- IEC and advocacy activities 1997-2001
- Supply of contraceptives and essential obstetric drugs
- RH survey
- Local training for health workers on RH services
Government commitment
- Provision of free services related to pregnancy and child birth
- Provision of manpower
- Support programme implementation and logistics
- Support programme implementation and logistics
- Support programme implementation and logistics
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN 2000-2003
MONGOLIA
Problems:
I. Poor quality of maternal care 2. Poor knowledge of men and women on danger signs and complications of pregnancy 3. Poor communication and long distance of service delivery 4. Poor use of information system 5. Medical school is focused on curative care 6. Poor advocacy of safe motherhood/reproductive health among policy makers, decision makers
Objectives Activities Expected result Time Responsible Performance frame person/agency indicator
1. Improve quality Develop training - Knowledge and skills of 2000-2001 WHO Training materials of care materials on safe medical staff improved MHSW developed
motherhood - Midwives trained
Train 30 trainers Reduce MMR 2000-2003 30 trainers trained, from provinces, 400 midwives trained districts
Evaluate and Review existing situation; 2001 WHO Evaluation report monitor quality of make recommendations MHSW care on improvement
Recruit STC to Have a recommendations 2000 WHO Mission report review curriculum on improvement of 2001 MHSW Undergraduate and of medical existing curriculum postgraduate training college/medical cirr university
Required Source funds (USD)
1 500 WHO
7 400 WHO 49000 UNICEF, UN
FPA, ADB, MHSW
3 500 WHO
8 000 WHO
Workshop on Maternal Mortality Reduction
Summary Action Plan 2000-2003
Mongolia
Objectives Activities
Train obs/abroad (study tour)
Printing and distribution of standards
Train senior OB/GYN on safe motherhood standards
Supply of essential equipment
2. To improved Train heads and community directors of health
participation facilities
Train NGO activists and VHWs on danger signs of pregnancy
To establish funds for IEC awareness
Improve use of Review and improve
information MMcard
Expected result Time frame
Improve 2000-2002
knowledge/skill, attitude of doctors
Save with above 2000-2002
Introduced standards same into practice
Improved supply and 2000-2002
availability of equipment
Take support and 2001 increase knowledge 2003
Increased access to 2001 information
Increased IEC 2000 activities 2001
2002
Improve quality of 2000 care
Responsible Performance Required Source
person/agency indicator funds (USD)
WHO Developed 9 key 45 000 WHO
MHSW specialists and managers trained
WHO Nat. RH standards 5 000 WHO
MHSW delivered to SDPs
WHO Total 30 OB/GYNs 4000 WHO
MHSW trained
WHO Quality of care 200 000 WHO
UNICEF improved UNICEF
UNFPA 80 peoples trained 10 000 UNFPA
UNICEF UNICEF
UNICEF Change attitude 12 000 UNICEF
I 00 NGO activists trained
WHO Have operational fund 15 000 Local
UNFPA government
UNICEF
WHO % of card users MHSW
MHSW increased (properly) MCHRC
Workshop on Maternal Mortality Reduction Summary Action Plan 2000-2003 Mongolia
Objectives Activities
Support and introduce MMR case review in health facilities
Develop indicators to measure quality of services
Improve referral of Review and improve high risk women referral guidelines and complicated cases
Support maternity waiting homes in provincial centre
Expected result Time frame
Improve quality care 2000 2001
Same 2000 2001
Improved access to 2000 essential and 2001 specialized obstetrics care
Improved access to 2000-2001 specialized obstetrics care
Responsible Performance Required Source person/agency indicator funds
(USD)
WHO Increase number of WHO MHSW centers used properly MCHRC
WHO Successful use of WHO MHSW indicators MCHRC
WHO Developed and Local WHO MHSW distributed and government MCHRC MCHRC implemented organization
guidelines on referral will be maternity care responsible
for the budget required
WHO Increased % of MHSW number of mother with MCHRC high risk and obs.
Complications referred to the provincial and state maternity hospitals
Agency Program!Project Assistin2 Title
Government of MCH PNG
WHO RH
VBA RETA
CH & nutrition UNICEF UNFPA Strengthening RH
Population
ADB RETA
HSDP
AU SAID WCHP
STD/HIV
HSSD
WORKSHOP ON MATERNAL MORTALITY REDUCTION COUNTRY SITUATIONAL ANALYSIS
PAPUA NEW GUINEA
Major Activities Geographical area Duration
ANC, PNC, Delivery, FP, Management PNG 6 years
of gyn problems, Reproductive health education
Technical support 4 provinces 4 years
Increase health centre delivery Milne bay and EHP 2 years
Reduce maternal mortality in PNG by Country wide 6 months
- country analysis
- policy agreement
- increase immunization coverage, Milne bay and Madang 2 years
- reduce malnutrition
IEC (radio, pamphlets, community 4 provinces 4 years
awareness, adolescent RH information, and peer group training) Stafftraining, midwifery, special skills (vasectomy & TL) Equipment for RH Policy document & advocacy problems country wide 2 years
ditto above country wide 6 months
Hospital technical equipment country wide 4 years
Strengthening maternal & child health country wide 4 years
Reduce HIV epidemic country wide 3 years
Strengthening rural health infrastructure country wide 4 years
Fund Source in Government kina commitment
2. 7million
1.2 million
1.2 million
ADB
170 million Usd LOAN
70 million
15 million
110 million
Issues/Problems Objectives
AUSAID WCHP
STDIHIV
HSSD
55% unsupervised Increase% rural deliveries deliveries at MMR574 rural health resulting in 79.7% centres maternal deaths
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN
PAPUA NEW GUINEA
Activities Expected Time frame Responsible Performance results person indicator
Strengthening country wide 4 years 70 million maternal & child health country wide 3 years 15 million
Reduce HIV country wide 4 years 110 million epidemic
Strengthening rural health infrastructure
Survey of Increased 10 years Family health % supervised
health centres supervised of DOH deliveries
with delivery rate to -HC community 85% -hospital survey. Introduce idea ofVHC and birthing at HC
Renovation of health centres as required.
Resource required
Finance AU SAid (HSSP)
Workshop on Maternal Mortality Reduction Summary Action Plan Papua New Guinea
Issues/Problems Objectives Activities
Midwife in Increase every health midwifery centre (50 training places church, 136 from 50 to gov't.) 150/year (2
new schools)
Increase Training VHC community involvement
Increase Strengthen community outreach in FP involvement and ANC
-risk identification (picture cards) - AN decision re TL or temp FP method - birth plan
Expected Time frame results
Increase supervised deliveries
Responsible Performance Resource person indicator required
Human I midwives Finance UNICEF resource dept. trained DOH 2. midwives
employed in HC
Guidelines Number of from training VHCin division DOH, villages PNGO&G Vaccination society and coverage university, Nutrition status supervised at <5yrs FP provincial level acceptance by provincial ANC advisor attendance
Provincial Finance AUDAid obstetrician
Picture cards SCF
Workshop on Maternal Mortality Reduction Summary Action Plan Papua New Guinea
Issues/Problems Objectives Activities
Education Emphasize 3 cleans, nutrition, FP, pregnancy and birth planning, STD prevention
Training and supervision -Clinical supervisory visit and in-service training -Nursing standards labour monitoring cleanliness drug storage and use (oxytocin, misoprostol, vaccine) - Management supplies, power, water, transport communications
Expected Time frame Responsible Performance Resource results nerson indicator required
Health AUSAid promotion division DOH
All HC functional for all aspects of HC deliveries Finance AUSAid/ ANC delivery Provincial WCHP service, obstetrician postnatal care and meeting FP needs
Provincial health
VI 0
Agency assisting Programme/project
1. Government
2. WHO Operational research on the use of partograph
3. UNICEF CPC V maternal health and nutrition programme
WORKSHOP ON MATERNAL MORTALITY REDUCTION COUNTRY SITUATIONAL ANALYSIS
PHILIPPINES
Major activities Geographical Duration Fund source area
- Development of safe motherhood Nationwide 2000 GOP policy
- Development of adolescent and youth health policy
- Monitoring and evaluation
- PMAC prevention and management of abortion and its complication
- Identification of suitable area Laguna 1996-1997 WHO/DOH/UNICEF/ AusAID
- Orientation of health worker
- Evaluation of training programme
- Implementation
- Data collection
-Dissemination of result and discussion of implication
Provision of supplies and training 20 provinces, 1993-2003 UNICEF fund 5 cities
Government commitment
Technical assistance in the development of policy/standard guidelines
Travelling expenses and per diem
LGU -TEVs
LGU and DOH- TEVs and per diem
Workshop on Maternal Mortality Reduction
Country Situational Analysis Philippines
Agency assisting Programme/project
4. UNFPA Reproductive health project
5. ADB ICHSP
Major activities
Pilot RH element implementation with facility and capability upgrading
Improve the efficiency and effectiveness of the health care delivery system through a comprehensive approach to health system development at the local level
Geographical area Duration
9 provinces, 2000-2004 4 cities
Kalinga, Apayao 1998-2002 Pal a wan Guimaras South Cotabato, and Surigao del Norte
Fund source
UNFPA
ADB
Government commitment
LGU and DOH- TEVs and per diem
LGU and DOH- TEVs and per diem
U1 N
Issues/problems Objectives
1. High maternal Reduce maternal mortality rate mortality ratio to
86 deaths per 2. Low Birth 100,000 Weight of babies livebirths by
year 2004. 3. Mortality rate (Baseline 172 of neonates deaths per
100,000 livebirths in 1998, NDHS)
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN
PHILIPPINES, 2000-2005
Activties Expected Time frame Responsible Performance Results persons/agencies indicator
l. Development Copies dissemi- Jun - Aug MCHS/SM Approved and and approval of nated to all Coordinator signed by the National Policy regions and Secretary of Health onSM,RH, interested AYHandPMAC institutions/
agencies
2. Orientation & MMRTeam July-Sep Regional and Orientation, organization of organized in provincial organization of theMMR Team Regions. V, VIII, MMRteam in 3 priority CAR conducted regions w/ high MMR (Regions V, VIII, CAR)
3. Conduct of On-going review Oct-Dec MCHS/WHSMP All 1999 maternal MMR for every deaths reviewed
maternal death
Resource Source required
Reams of DOH-MCHS bond paper
Training fund DOH, UNICEF, LGU {TEVs, per diem
MMRtool , LGUs TEVs
Workshop on Maternal Mortality Reduction Summary Action Plan Philippines, 2000-2005
Issues/problems Objectives Activties
Reduce the 4. Training of proportion of the first level LBW to 12% of referral doctors total livebirth in the priority (Baseline 16.6% areas (Regions in I 998 NDHS, V, VIII, CAR) 1997 FHSIS)
Reduce mortality 5. Adaptation of rate to 3.0 OB emergency neonates per manual 1 ,000 livebirths. (Baseline 7.8/1,000 livebirths in PHS 1994)
6. TOT on the use ofthe partograph
7. SM-GIS
Expected Results
Trained doctors able to manage OB emergency cases
Adaptation of WHO generic manual to Philippine use
Trained regional coordinator on the use of partograph
Equitable resource allocation
Time frame Responsible Performance Resource Source
persons/agencies indicator required
June-Dec MCHS All district Training funds, WHSMP hospitals in 3 TEVs, per diems regions with at least I trained FLRD
July-Dec MCHS Manual adapted Funds, UNICEF writeshop supplies
Oct-Dec MCHS All regional Training funds, GOP coordinators TEV s, per diem trained
June-Dec MCHS Data collected/ Travelling GOP installed expenses, per
diem of data collection, GPS, camera, computer forms
Workshop on Maternal Mortality Reduction Summary Action Plan Philippines, 2000-2005
Issues/problems Objectives Activties
8. Procurement, distribution of micronutrient supplementation (Vit. A, iron, multiple vitamins)
9. FFL training
10. Monitoring and evaluation
Expected Time frame Responsible Results persons/agencies
Women of June-Dec MCHS reproductive age receiving
Regions
Trainees able to Aug-Nov MCHS train illiterate women
SM programmes June-Nov MCHS implementation monitored
Performance indicator
Micronutrient supplementation available in health facilities
Training conducted in CPC V areas
Monitoring and evaluation of regional and provincial implementation of SM programme
Resource required
Micronutrient, freight
Training fund, supplies, traveling expenses, per diem
Travelling expenses, integrated monitoring checklist
Source
WHSMP
UNICEF/DOH/ HSMP
UNICEF/DOH
GOP
U1 U1
Issues/problems Objectives Activties
I. Orientation and organization of MMR team on the rest of the 13 regions
2. Conduct of MMRin all regions
3. Training of FLRD
4. TOT on the use ofEOC manual to complement the training of FLRD
5. Training of implementation on the use of partograph
SUMMARY OF ACTION PLAN 2001
Philippines
Expected Results Time frame Responsible persons/agencies
MMRteam Jan-Dec MCHS organized in 13 regions
On-going review 2001-2005 MCHS for every maternal death. Results analyzed and recommendations dessiminated
District hospitals in 2001-2002 617 regions able to perform OB emergency management
Doctors, nurses 2001-2002 MCHS able to perform OB emergency management
Nurses, midwives, 2001-2002 Regions monitor labor using the partograph in the periphery
Performance Resource Source indicator required
Orientation, Orientation, UNICEFIUNFPA organization of fund, TEVs, MMRteam per diem conducted
Every cases of MMR tools, LGUs maternal deaths TEVs reviewed
All district Training fund, WHSMP,LGUs hospitals in 6/7 per diem, regions with at TEVs least 1 trained on FLRD
All district Training fund, UNICEFIUNFPA hospital with TEVs per diem trained doctors, nurses on EOC manual
Number of Training fund, UNICEFIUNFPA/ nurses, TEVs, per MCHS midwives diem trained on partograph
Summary of Action Plan 2001 Philippines
Issues/problems Objectives Activties
6. Upgrading of facilities
7. Zonal meetings
8. Multisectoral consultative/plan ning workshop to encourage political commitment
9. Civil works
10. Revision of the maternal care manual for midwives
Expected Results Time frame
Accessible 2001-2004
functional facilities
Agreements, Jan-Dec commitment
Strengthened partnership/support 5% budget utilized - communication support (e.g. transportation)
Functional 2001-2002
Copies used as Jan-March reference guide
Responsible Performance
personsla2encies indicator
MCHS/WHSMP Number of facilities upgraded
MCHSIUNICEF 4 zonal meetings conducted
Agreements/plan of action
WHSMP - I 0 lying-in - 15 maternity waiting homes - 10 halfway nurses
MCHS Revised edition
Resource required
Construction budget, fund for supplies and equipment
Meetings fund, TEVs
Fund, TEVs, per diem
Construction budget
Budget for revision/ production
Source
WHSMP, UNFPA
MCHSIUNICEF
MCHS
WHSMPIUNFPA
UNFPA/WHO
U1 00
Issues/problems Objectives Activties
1. Training of H.C. doctors, nurses, midwives on OEC in CPC V areas
2. Integration of OEC in the midwives, nursing and medical curriculum
3. Expansion of FFL training to non-CPC V areas
4. Integration of functional two way referral system in the health district system
SUMMARY ACTION PLAN 2002
Philippines
Expected Time frame Responsible Results persons/a!!encies
Doctors, 2002-2004 Regions/provincial nurses, midwives in H.C., lying-in, maternity waiting homes, halfway homes able to respond to OEC before referral to higher level
Doctors, nurses March Regional/provincial and midwives able to perform OEC after graduation.
Trainees able May WHSMP/MCHS to train women to become literate functional Functional Jan-March two-way referral
Performance Resource Source indicator required
Number of Training fund, UNICEF doctors, nurses, TEVs, per diem midwives trained
OECand Management UNICEF/UNFPA
integrated in the funds, workshop curriculum funds, curriculum
development
Number of trained Training fund, UNFPAIMCHS
FFL TEVs, per diem
Organized two- Orientation/mana MCHS
way functional gement funds, referral system in logistics funds district health system
Summary Action Plan 2002 Philippines
Issues/problems Objectives Activties
5. Regional meeting with TBAs, "Strengthening support" redirecting roles in the community participation for safe motherhood
6. Translation/product ion/distribution of IEC prototype to local dialect
7. Updating ofSM website
8. Development of IEC materials on postpartum and early pregnancy
Expected Results
TBAs participation in various activities (e.g. health promotion)
- Copies read by the community -Copies used in health promotion campaign
Interested parties able to access SM programme-Philippines
Distributed to Regional offices for adaptation/ reproduction/ distribution
Time Responsible Performance
frame persons/agencies indicator
April Regional MCH Registration of
coordinator active TBAs
2002-2005 Regions Number of copies available
2000-2005 PIRES Continued updates
June MCHS/PIHES Prototype developed
Resource required
Meeting funds (16 regions), TEVs, DSA
Logistical supplies
Logistical supplies
Source
UNlCEF/MCHS
MCHS/PIHES
MCHS/PIHES
MCHS/PIHES
0\ 0
Issues/problems Objectives Activties
I. Training of health center doctors, nurses and midwives on OEC in non-CPC V areas
2. Follow-up meeting with TBAs by regions
3. Programme review on safe motherhood RH
SUMMARY ACTION PLAN 2003
Philippines
Expected Results Time frame Responsible persons/agencies
Doctors, nurses, 2003-2005 Regions/provincial midwives in health offices health center, lying-in, maternity waiting homes, able to respond to OEC before referral
Documentation of May Region the past year Trained Birth Attendant (TBA) community participation
Documented March MCHS status of programme performance by regions
Performance Resource Source indicator required
Number of Training fund, UNFPA doctors, nurses, TEVs, per diem midwives trained
Attendance to Meetings fund, UNICEF/ meetings TEVs, DSA MCHS
Programme Workshop fund, UNICEF/ review conducted per diem, TEVs MCHS
Issues/problems Objectives Activties
I. Documentation and expansion of best practices (e.g. health & financing
2. Advocate for legislation
- Increasing maternity leave from 2 months to four months for the 1st & 2nd child w/ birth space of 2 years & above
-Training of nurse anesthetist
- BF room for every establishments
SUMMARY ACTION PLAN 2004-2005 Philippines
Expected Results Time frame Responsible
2004 2005 persons/agencies
communities/ X Regional Offices facilities implementing health care financing
Approved bill X MCHS
Performance Resource Source indicator required
Document, list of TEVs MCHS/ communities/ DSA Region facilities Logistics
Copy of bill MCHS proposal
Nurse anesthetist trained
Agency Programme/project assisting
UNFPA Strengthening RH Services
UNFPA/ RH Initiative EU
UNICEF District Action Plan on Safe Motherhood
WORKSHOP ON MATERNAL MORTALITY REDUCTION COUNTRY SITUATIONAL ANALYSIS
VIETNAM
Activity Geographic area
Integration Delivery care with FP and RH components. 8 Provinces
SM components: - Policy level: clinical guidelines, Procedures and Responsibilities for every level of care. - Improving services and capacity in 8 provinces. - Counselling and IEC for community.
Adolescent RH through local NGOs and local people Hanoi and Hue
committees cities
Focus on promoting Home-based Pregnancy Record, and EOC 18 districts of 16
in commune and district levels. provinces.
Reduction MMR by: Capacity building for health personnel at all levels, for Nutrition program
-Community (TBAs), strengthen midwifery training at school. covers the whole
- Upgrading Health services: provision basic supply and country.
equipment, set up a functioning referral system, use of
delivery kit in all home delivery. - Community empowerment. -Nutrition, vitamin A, iron, iodine, and training.
Funding/ Government Duration
1997-2000 Yes (30%?) (US$4 million)
1999-2001 Yes
1996-2000 Yes (20%)
PHC- Safe Mother hood (US$400,000/ year) -Nutrition (US$800,000/ year)
Workshop on Maternal Mortality Reduction
Country Situational Analysis VietNam
Agency Programme/project Activity
assisting Buffet, Training for Safe Capacity building for maternal care technical provider, especially in
Netherlands Motherhood and care their areas of knowledge and skills of infection prevention, ANC,
Government of the Newborn management of normaJ deliveries/newborn care.
andAUSAJD Initiative (SMCN) -Training -Equipment and supplies -Infrastructure
SCFIUS Safe Motherhood Life-skills Training for midwives, ANC, cJean and safe delivery,
training on AN skills for mother and community through regular
group meeting by the pregnant women. Mother to mother group. Support to family for revolving fund. Su_pport mother-mother group.
JICA Safe Motherhood ANC and pregnancy management through promoting community
involvement by Mother-Mother groups and share experiences
among groups within villages and communes.
Training of midwives and community workers.
World Bank Clean delivery Provide clean environment and clean water supply for clean and
safe delivery, promoting the use ofPartograph.
Infrastructure and equipment Ambulance. Training Midwives, Nurses, TBAs and community workers.
ADB Support for Rural Primary Health Care:
Health -equipment and supplies for District hospital
- Infrastructure for District Hospital. - Training for doctors, midwives and village health workers for all
levels.
Geographic area Funding/ Govern Duration ment
8 provinces: MCH 1999-2000- Yes
centers 2004 US$6 million
Thanh Hoa 1995-2000 Yes
province, 1 0 districts
3 districts ofNghe 1997-2000- Yes
an province 2005
16 provinces, 1 0 1998-2003 Yes
district per province
13 provinces 2001-2005 Yes US$100 Govt. million 30%
Workshop on Maternal Mortality Reduction Country Situational Analysis VietNam
Agency Programme/projec Activity
assistin2 t
AU SAID Strengthen the Strengthen the capacity of provincial MCHIFP centers
capacity of provincial MCHIFP centers
GOVT Kangaroo mother Comprehensive Care for low birth weight infant
care •
Marie Stopes Improve quality of -Set up clinic
International EOC -contraceptive methods/sterilization -safe abortion -EOC
UNICEF/WHO Breastfeeding -Promotion of breastfeeding program -Training and education materials development for secondary
medical school -Baby-friendly hospital with international standard -Implementation of international code
GOVT Safe Motherhood Training Project Supplies, equipment
Infrastructure, clean water supply Monitoring and supervision Management information system
Geographic area Funding/ Govern Duration ment
5 provinces ? Yes 5 y (1998-2003)
1 central hospital Ongoing 100% and 1 provincial hospital
6 provinces/one 2000-2003 Yes clinic each mobile clinic
20 provinces + 13 1995 -2005 Yes provinces (2000)+28 provinces by 2005
76 central/provinces hospital ( 46 already covered) by 2005 Pilot in 5 l00%GVT 100% provinces, 5 districts each, 5 2 y (1997-99) communes each: total 125 CHCs
Issue/problem ObjectivesS
HR.: Lack of 100% CHCs with Midwives midwives by 2005
(about 2000 midwives)
Lack of updated Re-training of all knowledge existing midwives
by 2005
Lack of doctors with 40% CHCs have obstetric emergency doctor with obst. knowledge at CHC emergency
training by 2000 (about 4000 doctors)
Lack of health To cover the workers with needs with HWs training in basic trained on basic obst.care in CHCs obst. Care (about
5000)
WORKSHOP ON MATERNAL MORTALITY REDUCTION SUMMARY ACTION PLAN
VIETNAM
Activities Expected Results Time Responsible frame person
Training of new At least 1 trained Provincial
midwives midwife in each 36M secondary/medica
Redeployment CHC providing SM I school: training
DIC and C/C services* Commune: identify midwives
Re-training of At least I trained 5Y Provincial MCH
about 5000 midwife or HW with center: re-training
existing midwives basic obst.care in Commune: each CHC providing identify midwives
TOT SM services* Central level
Training 1500 At least 1 doctor going Central medical
Redeployment with obst. schools
500 centrai/P/D/C Emergency training in 40% of CHCs**
Training of 5000 At least I trained 6M Provincial MCH
HWs on basic midwife or HW with centers/ hospitals
obst.care basic obst.care in each CHC providing
TOT SM services* Central level
Indicator Resources Sources
%ofCHCs Yes GVT with at least (1000) I trained Gap: 300 UNFPA midwife WHO? (700)
% ofre- Yes GVT trained (3000) midwives Gap: UNICEF
I500 (500) ?
%of doctors Yes GVT in the CHCs
%of trained Yes GVT HWsin UNFPA CHCs Gap: 40% WB
CHCs ?
Workshop on Maternal Mortality Reduction
Summary Action Plan VietNam
Issue/problem ObjectivesS
Lack of doctors with 40% CHCs have
obstetric emergency doctor with obst.
knowledge at CHC emergency training by 2000 (about 4000 doctors)
Lack of health To cover the workers with needs with HWs training in basic trained on basic obst.care in CHCs obst. Care (about
5000)
There are too many Uniform curricula different curricula and training and training materials by 2001 materials
Need of improve To strengthen capacity MOH management management, capacity at monitoring and MOH!RHto supervision of RH provide assistance
to provinces
Activities Expected Results
Training 1500 At least l doctor Redeployment with obst. 500 central/P/D/C Emergency training
in 40% ofCHCs**
Training of 5000 At least 1 trained HWs on basic midwife or HW with obst.care basic obst.care in
each CHC providing TOT SM services*
Revise curricula Coordination and all and training agencies to use the materials same curriculum and WorkshopRH training materials Selection of curriculum and training materials Training Quality service Development of clinical/ monitoring/ training guidelines
Time Responsible Indicator Resources Sources
frame person going Central medical %of doctors Yes GVT
schools in the CHCs
6M Provincial MCH %of trained Yes GVT
centers/ hospitals HWsin UNFPA CHCs Gap: 40% WB
CHCs
Central level ?
1-2 y MOH:MCHand Same curr. Gap: GVT
training And training WHO WHO
departments materials UNFPA UNFPA
will be used GTZ Pathfinder
by all Other? GTZ agencies
5Y MOH Standardized UNFPA GVT
Provincial people documents UNFPA
committees available
Workshop on Maternal Mortality Reduction Summary Action Plan VietNam
Issue/problem ObjectivesS
Low access to 100% communes service/ referral have SM Difficult committees communication Low community involvement
Lack of standard To have 100% delivery room in CHCswith about 5000 CHCs standard delivery
room by 2005
Activities
Organize commune committees Arrange transportation To provide phone in each CHC to call ambulance Support to poor people
Identify CHCs Provide standards for improvement Upgrade CHCs
SM services CHC provided by trained midwife: ANC care at least 3 times per pregnancy Normal delivery Referral of high risk pregnancies Post-partum 2 visits per pregnancy
Expected Results
Early detection of early pregnancy and ofhigh risk pregnancies Improve CHCs referral capacity Reduce delay
To have improved CHCs for clean delivery
Immediate newborn care (resuscitation and thermal protection)
Post-natal visits 2 Immunization Breast feeding counselling FP
EOC services provided by the doctor: -Manual removal ofplacenta - Removal incomplete abortion - IV treatment
Time Responsible Indicator Resources Sources
frame person 5Y Director DHC % of high risk GVT GVT
Leader of pregnancies Gap People
commune identified on ambulance: UNICEF
committees total 150 DHs (phones) WB
pregnancies Gap phone: (ambulance) 8000 CHCs
5Y Director PHS %ofCHCs GVT
Leader of upgraded ADB
commune WB
committees