Monitoring obstetric services: putting the UN guidelines into practice in Malawi. I: developing the system

Abstract

The UNICEF/WHO/ UNFPA "Guidelines for Monitoring the Availability and Use of Obstetric Services" was published in 1997 as a guide for implementing process indicators. The Malawi Safe Motherhood Project covers 5 million people and was the first large project to introduce the new indicators as part of a routine monitoring system. A rigorous process of needs assessment, tools development, operations research, field testing and training was conducted. It was necessary to reach agreement on locally appropriate standard definitions of obstetric emergencies, reporting formats and catchment populations. Underreporting of emergencies, misreporting of maternal deaths and double counting of referrals were minimized by improving recording tools. Time, cost, political and technical inputs are important considerations--in Malawi, the system took 1 year to set up at a cost of $100 000. Developing a routine monitoring system to obtain data for the process indicators is feasible, but requires adaptation of the cross-sectional evaluation methods described in the UN Guidelines.

Emergency obstetric care: How do we stand in Malawi?

“…These indicators have been used to assess services available at selected hospitals in other countries [4]. In fact, as early as 1998, the Malawi Safe Motherhood Project introduced these indicators throughout the Southern Region of the country as part of a routine monitoring system, and collected and analyzed data for 3 consecutive years following its introduction [5,6]. Our study confirmed that for most indicators, the Malawi health system did not meet the recommended levels.…”

Are Process Indicators Adequate to Assess Essential Obstetric Care at District Level?: A Case Study from Rufiji District, Tanzania

“…Under-reporting of obstetric emergencies and over-reporting due to double counting have been observed in a system developed to monitor obstetric services in Malawi 22 . A comprehensive parallel data collection, as the one instituted in this study may be more reliable.…”

Childbirth attendance strategies and their impact on maternal mortality and morbidity in low‐income settings: a systematic review

“…Goodburn et al used a prospective cohort design to study the effectiveness of TBA training in preventing postpartum infection in Bangladesh (35). The percentage of TBAs who practiced the “three cleans” (hands, surface and umbilical cord) was significantly higher among the trained group (45 vs. 19%), but there was no significant reduction in the incidence of postpartum infections.…”