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~ Mothercare- U S Agency for International Development -· MotherCare Summary Report October 1, 1993 - September 30, 1997 and Annual Workplan October 1, 1997 - September 30, 1998 liff,ift) ~ t~W•'J: ~ MotherCare- U S Agency for International Development -·"9--· .. Office of Health :W:-): John Snow, Inc This publication was made possible through support provided by the Office of Health and Nutnt10n Umted States Agency for International Development (USAID), under the terms of Contract No HRN-C-00-93-00038-00 and John Snow, Incorporated (JSI) The contents and opmions expressed herem are those of the author(s) and do not necessarily reflect the views ofUSAID and JSI Table of Contents A Country Map ,.., B MotherCare s V is10n -' ,.., c MotherCare s Conceptual Framework(s)/Pathway -' • Figure 1 Conceptual Framework of Safe Pregnancy Program Demand and Supply 4 • Figure 2 How Does Essential Obstetric Care Fit mto this Framework? 5 • Figure 3 Mother/Baby Package 6 • Figure 4 Elements of EOC 6 • Figure 5 Pathway to Survival 7 D MotherCare's Integrated Reproductive Health Approach 8 E MotherCare's Accomplishments (By USAID SOs and IRs) 11 F MotherCare m Act10n - Country Specific Interventions • Box 1 A Partnership to Improve Maternal and Newborn Care m Indonesia 21 • Box 2 From Research to Action The Development of an IEC Campaign m South Kahmantan, Indonesia 22 • Box 3 Introducmg Family-Centered Maternity Care (FCMC) m Moldova 23 • Box 4 Expansion of Family-Centered Maternity Care m Ukraine 24 G Fmancial Summary of Years 1 - 4 25 H MotherCare Workplan for Year 5 27 Appendices 1 DO Summary 47 2 FS Summary 51 3 Annual Workplan Budgets for Year 5 (Core and DO's) 55 4 Prehmmary Lessons Learned 59 5 Country Synopses 65 6 Applied Research Summary 95 7 Country Workplans 103 8 MotherCare Pubhcat1ons List , 175 9 MotherCare Web Site (summary ofh1ts) 189 10 MotherCare Products List 195 A MotherCare Countries of Involvement '11: 0 <Pb Integrated Reproductive Health Projects Bolivia, Egv-pt, Guatemala, Indonesia, Honduras fnd1a, Pakistan Targeted Interventions Benm, Entrea, Gumea, India, Malawi, Moldova, Peru, Russia, Ukrame, Zambia Applied Research Pro1ects Ghana, Indonesia, Peru, Thailand, Uganda Reg10nal Pro1ects Latm Ame1 tea (Boltv1a, Ecuador, Hondurac;) Afnca (Ghana Malawi, Uganda) Dtcembo 30 1997 B MOTHERCARE'S VISION Reproductive health is a state ofcomplete phvsical mental and social well-be mg and not me1 elv the absence of disease or znfirmit} zn all matters relatzng to the reproductive svstem and to its functwns and processes (Chapter 7 7 2, Programme of Act10n, ICPD Cairo 1994) MotherCare seeks to implement a woman-centered approach for reproductive health care through a broad range of mtervent10ns, mcludmg commumty-based approaches to maternal and pennatal mortality reduction quality antenatal care mcludmg prevention and control of sexuall) transmitted diseases, plus improved nutnt10n through educat10n and distnbut1on of 1ron-folate tablets improved normal deliverv care and management of complications, postpartum services aimed at recogmzmg and treatmg complicat10ns and special newborn care, mcludmg exclusive breastfeedmg and post-partum/post-abort1on family plannmg MotherCare 1s findmg ways to improve the dehvery ofth1s mtegrated reproductive health package most effectively through the ngorous use of quahtatlve and quant1tat1ve research techmques applied m different field settmgs MotherCare env1s1ons the reduct10n of maternal and neonatal mortality m the long-term, a more immediate mcrease m demand and utihzat10n of such services, and the accurate assessment of the impact of any mtervent10ns Furthermore MotherCare stnves to effect pohcy with its results and findmgs of such assessments By these means, MotherCare strives " to demonstrate the feas1b1hty of prov1dmg a package of effective, appropriate maternal and neonatal care services and education to women and their mfants m selected developmg country settmgs " (Project Purpose, Project Design Summary Logical Framework, MotherCare I Fmal Evaluat10n August 1993) MotherCare s mtegrated approach 1s outlmed m Sect10n D below C MOTHERCARE'S CONCEPTUAL FRAMEWORK AND PATHWAY TO SURVIVAL MotherCare's framework for understandmg Safe Motherhood 1s comprised of both supply and demand mputs as conceptualized m Figure 1 below This framework summarizes how mputs of a program are converted through processes (activities) to produce results at the program level (outputs) and, over time changes at the population level (outcomes) Specifically, this framework demonstrates how maternal and permatal health mtervent10ns are expected to impact on populat10n-based behav10rs MotherCare views Safe Motherhood outcomes not only m terms of survival of the woman and newborn but also m terms of their health F \WORKPLAN\FRAMEWK WPD 3 Previous Page Blank Figure 1 Conceptual Framework of Safe Pregnancy Program Demand and Supply Program Impact on Maternal/Pennatal Mortality and Im proved Health Demand Soc1etal/cultural and md1v1dual factors Pregnancy Status Service demand status - Education - Cultural factors - Wantedness - Normal - Complicated - Com phcated status - Women's health status - Value for women - Health related - Recogn1t1on Reduced maternal & - Women's nutnttonal status and newborns behav10rs - Family dec1s1on-makmg permatal/neonatal - SES - Demand for children - Costs mortality - Transport • Appropriate ""' ! Service I ! ~se ~~~~~~~~~~~~~~~~~~~~~~~J~I Supply Pohttcal & Organ1zattonal Operations - safe Service supply structure - safe pregnancy services* - A va1lable access • ' adm m1strattve ... ~..,,, Improved health system pregnancy services* - Management - Quality of women and - Service superv1s10n - lmage/Acceptab1hty - Poht1cal support newborns - Resource infrastructure - Trammg - Efficiency allocatton - Sectoral integration - Commodity acqu1s1t10n/ - Legal code/ - Delivery strategies d1stnbut10n 4'- regu lat10ns - Pubhc/pnvate - IEC partnerships - Research and evaluatton - A I arm and transport OUTPUTS OUTCOMES ... ~ INPUTS I PROCESS I I (health 1m pact) *Prenatal Care Essential Obstetric Care (EsOC) Special Neonatal Care (N<iC') Source The Evaluation Project F \WORKPLAN\FRAMEWK WPD ~ On the demand side soc10-cultural and ind1v1dual factors influence the value placed on women and newborns their health and nutritional status and the demand for children These factors m turn affect pregnancy status and demand for services Appropriate use of services and improved health behav10rs will result ma declme in maternal and permatal mortality and improved health for the mother and newborn if they are met by quality services Appropriate service demand depends on the woman s pregnancy status Many types of providers may be able to manage normal pregnancies, but maternal complications and those complications that may kill a newborn require specialized care often at a greater distance and cost to the family than normal pregnanC\ care Recogmt1on of these complicat10ns and appropriate and timely response, by families Figure 2 How does Essential Obstetric Care fit mto this framework? and providers, are essential for the survival of the woman and the EOC mcludes the management of problem pregnancies and referral for newborn such problems as anemia preeclampsia and prolonged labor EOC includes early detect10n and treatment to prevent the progression of Quality services are imbedded in problems so that they do not become emergencies as well as the treatment of severe poht1cal and adnumstrat1ve comphcat1ons systems, organ1zat10nal Emergency Obstetric Care (EmOC) 1s a subset ofEOC and responds to structures, and service and unexpected comphcat1ons such as hemorrhage and obstructed labor It operational elements on the does not include management of problem pregnancies momtonng of supply side (program level) labor or neonatal care Directed at savmg women s hves EmOC includes blood and IV transfus10n, These elements impact on the parenteral ant1b10t1cs oxytoc1cs and sedatives Cesarean section ventouse or forceps delivery, and manual availab1hty, access, quality removal of the placenta and evacuation ofretamed products of image and acceptability of conception Suturing laparotomy and hemoglobin est1mat1on would services offered at delivery sites also be included Moreover essential obstetric care However, focusing on EmOC does (see Figures 2 and 4) the maJor not allow for earlv 1dent1ficat1011 of comphcat10ns and prevention of their progression to hfe-threatenmg service intervent10n aimed at emergencies A broader array of essential obstetric care services may managmg the direct obstetric help to decrease the seventy of comphcat10ns and ensuing deaths (for comphcat1ons leadmg to maternal example severe anemia as a result of hemorrhage or obstetric fistula death does not stand alone It is and vaginal prolapse resulting from prolonged labor) EOC mcludes the partograph and maternal wa1tmg homes part of basic maternity care, plus all the elements listed 111 EmOC which includes appropriate prenatal and postpartum care, Services can be focused to emphasize 'basic' EOC another subset of plus normal b1rthmg care (as EOC It mcludes all EOC elements except surgery, anesthesia and shown m Figure 3 for the Mother­ blood replacement All pregnant women should receive these services which can be provided Baby Package of WHO) at the first referral level (health center maternity or basic hospital) by non-physician providers such as medically tramed m1dw1ves This approach does not demand highly The availab1hty, access and tramed ob/gyn spec1ahsts or fully equipped operatmg theaters and quality of
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