Delivery of maternal and newborn care services in africa what are the facilities telling us
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Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us?. Koye Oyerinde MD, MPH, FAAP Symposium on Maternal Mortality, Dakar. The Averting Maternal Death and Disability Program - AMDD. Mailman School of Public Health, Columbia University, New York City.

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Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us?

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Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us?

Koye Oyerinde MD, MPH, FAAP

Symposium on Maternal Mortality, Dakar

The Averting Maternal Death and Disability Program - AMDD

  • Mailman School of Public Health, Columbia University, New York City.

  • Help to strengthen heath systems to provide emergency care for all women experiencing life-threatening obstetric complications.

  • Conduct research and policy analysis, provide technical expertise, and advocate for solutions

  • Collaborate with global, regional, and local institutions – including NGOs & academic centers

The Alliance

  • Memorandum of Understanding signed June 2008 between UNICEF, UNFPA, AMDD

  • Alliance supports country plans for the strengthening of EmONC service delivery as a strategy for attaining MDGs 4 and 5.

  • WHO collaborates on alliance activities at country and regional level.

Needs Assessment Overview

  • The EmONC Needs Assessments are facility based cross-sectional studies of the capacity of a health system to provide health services to mothers and newborns

  • Main focus – health system.

    • Accessibility/Coverage/Equity

    • 24 hour services

    • Human Resources

    • Equipment and Supplies

    • Infrastructure

    • Aspects of quality of care

EmONC Needs Assessments

Completed – pre-2005 and/or sub-national

Completed – post-2005 and national



Current as of December 2010

The Needs Assessment Process

Phase III: From Data to Action

  • The AMDD team:

  • provides customized technical support and training through these phases

  • works remotely and in-country to support the MOH to conduct the assessments.

  • Conducting the Needs Assessment

Phase II: Conducting the Needs Assessment

Phase I: Advocacy and Planning

Some trends from the recent EmONC Needs Assessments in Africa

Low no. of facilities offering EmONC signal functions

The recommended number of EmONC facilities is 5 per 500,000, at least one of which is Comprehensive (CEmONC).

Coverage is defined as available EmONC facilities as a percentage of recommended EmONC facilities. There may be further disparities between urban and rural areas.

Low no. of EmONC facilities

  • Better CEmOC coverage than BEmOC coverage

    • But CEmOC requires BEmOC to function properly

Low utilization

  • Institutional delivery rate:

  • Variety within and among countries:

    • Ethiopia 7%,

    • Madagascar 19%

    • Sierra Leone 10%

    • Higher rates in urban areas

  • Met need:

  • % of expected complications that are treated in EmOC facilities. Target: 100%

Missing signal functions

  • MVA and AVD are most commonly missing SFs, especially at the health center level.

  • Sierra Leone, 2008: Proportion of hospitals and CHCs by signal functions performed in last 3 months

Low HR availability

  • Sierra Leone: TBAs and MCH aides conduct most deliveries, especially in health centers. SL has started new midwifery education programs since the NA

  • Madagascar: has 99 obstetricians, needs 72 more to reach norms.

  • Ethiopia: only 35% of the midwives targeted in HSDP III 2010 had been trained, 26% of medical doctors, and 16% of the health officers.

Ethiopia: % of HCs staffed with at least 2 midwives and 1 health officer, by region

Inadequate commodities and supplies

Percentages of facilities with:

Stock outs

Ethiopia: causes of delay of supplies in hospitals

‘stock out at

central store’ (41%)

‘financial problems’



difficulties’ (15%)

Madagascar: 73% of hospitals and 65% of healthcentershad not had a stock out of oxytocin, ergometrine, or atropine in the 12 monthsbefore the study.

Limited data collection

  • HMIS indicators

    • Often important indicators are not collected

      • When collected the data are unused for planning

    • HMIS data often considered unreliable

      • A common outcome of the Needs Assessment is HMIS revision.

  • Data collection at front-lines

    • Facility registers often unclear and incomplete

    • 51% of health centers in Ethiopia had drug and inventory registers

Fee for Service

  • Fees are often considered a barrier, especially for the poorest.

  • “Some women when told to go to the hospital would not because they do not have money; so they have problems during delivery” - Sierra Leone Needs Assessment, qualitative data:

  • Sierra Leone made health services for pregnant and lactating mothers and children under 5 free in spring 2010

    • Initial reports suggest a phenomenal increase in utilization; thus raising concerns for potential fall in quality of care

Socio-cultural barriers

  • NA results are made more meaningful when combined with social science research

  • Socio-cultural barriers – including abusive / disrespectful care - have been shown to delay utilization and limit benefits derived from the health system

An anthropologic question


  • Needs Assessments have potential to surface gaps and indicate ways forward

  • A systems science/health systems perspective is critical – we need strong health systems to support women during labor.


  • Health facilities in Africa are saying:

    • Not enough, not the right type and not in the right place

    • Not adequately staffed, not with the right skills

    • Not adequately stocked, not with the right tools, drugs, and supplies

Many thanks!Merci beaucoup!

Further resources available from the AMDD website: www.amddprogram .org

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