What Is Birth Preparedness and Complication Readiness?  And Evidence Based Practices for their implementation.

This document summarizes activities that save the lives of mothers and infants in the household and community. Information is provided on evidence-based practices and practice-based evidence to date, as well as how these can be implemented into an overall program. It is written for individuals and agencies that plan and manage maternal and infant health programs.

This briefing provides information on antenatal care as a key entry point for a broad range of health promotion and preventive health services. It highlights the importance of providing integrated, individualized care during pregnancy. It discusses antenatal care as an essential link in the household-to-hospital continuum of care.

The purpose of the prevention of postpartum hemorrhage (PPH) study, conducted in West Java, Indonesia, was to demonstrate the safety, acceptability, feasibility, and program effectiveness (SAFE) of community based distribution and use of oral misoprostol to reduce PPH in areas where a large proportion of births are not attended by skilled providers.  The study was funded by the United States Agency for International Development (USAID) and was a collaborative partnership between the Indonesian Department of Health and the Indonesia Association of Obstetricians and Gynecologists.  The study was implemented by the World Health Organization Collaborating Center in Bandung, and JHPIEGO's Maternal and Neonatal Health Program in Indonesia.

Guidelines for Assessment of Skilled Providers After Training in Maternal and Newborn Healthcare.

With the resurgence of interest in the IUD comes an increased need for providers who have knowledge, skill, and overall competency in providing quality IUD services.  To help address this need, JHPIEGO has updated and revised its IUD Guidelines for Family Planning Service Programs learning package, which includes a problem-solving reference manual, notebook for trainers, handbook for participants, and presentation graphics - all of the materials needed to conduct a competency-based, inservice training course for service providers.  The reference manual is a concise, up-to-date, evidence-based resource intended for use by family planning service providers, clinical managers or supervisors, and clinical trainers.  Although the manual can be used in the context of IUD Service delivery, it is designed to work primarily as a reference document during clinical training.  The course outline, exercises and other course materials are specifically keyed to work with the manual, which becomes a 'common ground' for trainers and participant-providers as they navigate together through the course.

This technical briefing outlines the need for safe, low-cost, evidence-based practices that prevent PPH in countries with high maternal mortality and limited resources to save women's lives.

This toolkit presents a process and tools that can be used to conduct facility-level site assessment and strengthening (SA/S) with the goal of improving essential maternal and newborn care services.  The SA/S activity is based on the performance improvement process defined by the USAID Performance Improvement Consultative Group, and adapted by JHPIEGO as a performance and quality improvement (PQI) approach. The source material adapted to form Part 1 of this toolkit is the reference manual Supervising Healthcare Services: Improving the Performance of People (Garrison, K et al. JHPIEGO 2004). The manual describes in more detail aspects of the PQI process from a supervisory perspective, including how to set performance standards, use assessment methods, and work with the community as a stakeholder.  The assessment tools presented in Part 2 were developed by the MNH Program and have been used during the past 6 years in more than a dozen countries. Because the tools use evidence-based, internationally recognized standards, they can be used by any organization working in the field of maternal and newborn care. Part 3 of the toolkit contains the report Using Performance and Quality Improvement to Strengthen Skilled Attendance JHPIEGO/MNH Program 2003). This report documents how the use of the PQI process has helped to improve skilled attendance in MNH Program countries, and shares some lessons the Program has learned about how best to use PQI in safe motherhood programs.  Taken together, this toolkit provides an overview of how the PQI process can be used to strengthen facility and individual performance and how it can be easily and effectively incorporated into the operating norms of any facility. Using the PQI process described in this toolkit, staff can continually assess and strengthen individual and facility-level performance.

emphasizes doing, not just knowing, and uses competency-based evaluation of performance.

The purpose of this brief is to guide health care service providers in offering quality Lactational Amenorrhea Method (LAM) services within their maternal and child health, reproductive health and family planning programs.

This brief explores some Faith Based Organizations health networks and facility based services in Uganda and Tanzania.  A pilot project in the Kasese District of Uganda illustrates how Protestant, Catholic and Muslim health care providers and communities can work together from household to hospital levels to improve health outcomes.  In addition, the brief describes community health programs focusing on behavior change - in particular, the World Relief Care Group Model in Mozambique.

This clinical training course is designed for service providers (physicians, nurses, and midwives). The course builds on each participant’s past knowledge and experience and takes advantage of the individual’s high motivation to accomplish the learning tasks in the minimum time. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance.

• In developing countries, over 60% of maternal deaths occur in the postpartum period, and about 70% of women receive no postpartum care.

• Effective care during the first week postpartum—especially during the first 24 hours—is essential to maximize survival of mothers and newborns.

• Women, their families and communities should be able to recognize maternal danger signs and have a plan for seeking appropriate care.

• Programs should manage the care of mother and newborn together, as the health and well-being of both are interdependent.

This report documents how the use of the Performance and Quality Improvement (PQI) process has helped to improve skilled attendance in Maternal and Newborn Health (MNH) Program countries, and shares some lessons the Program has learned about how best to use PQI in safe motherhood programs. The PQI process has guided MNH Program-led  efforts to improve the quality of care, strengthen links between the community and health facilities, and empower individuals and communities to seek and advocate for high-quality healthcare services.  These efforts have helped to build more effective and sustainable in country programs to reduce maternal and newborn mortality.

A rapidly growing number of the poorest, most vulnerable communities with the highest newborn and maternal mortality are demonstrating that they can successfully lead efforts to develop and implement culturally appropriate solutions to improve the health of mothers and newborns.  In a number of countries these comunities have reduced maternal and newborn mortality by 30% to over 60% in periods of 2 to 3 years.  Just as important, they are also actively engaged in building civil society by strengthening their capacity to achieve and sustain positive health and other development results.  To achieve these results, health programs are using community mobilization as a primary strategy, expanding their efforts to reach multiple districts and, in a few instances, national scale.  In spite of the growing evidence of encouraging results from such programs, some donors and policymakers who do not have experience with the transformational power of comunity mobilization as skeptical of the process, confused by the range of definitions and approaches, and they have raised a number of legitimate concerns: community mobilization is too messy; takes too long; is too time intensive; costs too much; and cannot achieve large-scale impact.  The purpose of this publication is to address these concerns and present evidence from the field to make the case for including community mobilization as part of broader national health plans to achieve the Millennium Development Goals of reducing maternal and child mortality and improving maternal and child health.

This technical brief offers information on the importance of providing HIV prevention, care and treatment within the existing maternal and child health services to dramatically improve uptake and reduce mother-to-child transmission of HIV.

Igniting Change! Capacity-Building Tools for Safe Motherhood Alliances is a collection of tools to help focus and strengthen collective efforts, from the grassroots to the policymaking level, to improve maternal and neonatal health. The tools were initially developed to support the Maternal and Neonatal Health (MNH) Program’s global efforts to raise awareness among safe motherhood stakeholders, mobilize resources, and move people to action to save women and newborns. These efforts, complemented by appropriate clinical interventions, enable the MNH Program to achieve its mission of increasing access to, demand for, and use of skilled maternal and newborn healthcare.

This document serves as a gender sensitivity assessment tool for family planning and reproductive health curricula.

Any approach to improve essential maternal and newborn care services must address the issues of the community and the health system together, systematically, and in close collaboration among all stakeholders if it is to be successful. Communities and health care providers need to join forces and work together to overcome these complex obstacles, with the long-term goal of ensuring that pregnant women and newborns receive appropriate and timely care-- preferably as close to home as possible. Achieving significant reductions in maternal and newborn morbidity and mortality will be facilitated by developing a comprehensive approach to address the social and health system issues in  the community, and at both peripheral and district-level facilities. This integrated approach to community- and facility-based maternal and newborn programming and implementation is called the Household-to-Hospital Continuum of Care (HHCC).

While the overall health of children has improved around the world, the death rate of newborns has hardly changed.  MDG 4 - to reduce child mortality by two-thirds between 1990 and 2015 - cannot be met without substantial reactions in neonatal mortality.  Over the past 4 years the ACCESS Program has worked globally, regionally and in 25 countries to improve newborn health and survival.  ACCESS programs address the 3 leading causes of newborn deaths - severe infections, birth asphyxia, and complications of prematurity/low birth weight - and promote ways to overcome the barriers to implementing these interventions at scale.  This report provides a synopsis of the ACCESS program's approach and results in shaping policy and programs to save newborn lives.