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Center for Population, Health and Nutrition
>> Return to Home Page >> Central Programs >> Global Programs >> Population, Health and Nutrition ACTIVITY DATA SHEET
PROGRAM: Central Programs
TITLE AND NUMBER: Increased use of key maternal health and nutrition interventions, 936-002
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $14,444,000 CSD
PROPOSED OBLIGATION AND FUNDING SOURCE: $14,400,000 CSD
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: ContinuingSummary: Each year, more than 500,000 women die as a result of pregnancy and child birth complications. Of those who survive obstetric complications, millions suffer long term disability. New global and regional maternal mortality estimates show a decline from 585,000 in 1990 to 515,000 in 1995 in annual maternal deaths. It is essential about half of the decline resulted from fewer births each year, with the remainder attributed to reduction in the risk associated with pregnancy.
This program focuses primarily on reduction of the risk associated with pregnancy and childbirth by improving maternal nutritional status, improving preparation for birth including: antenatal care, promoting safe and clean delivery practices, improving postpartum care, and treating obstetrical complications. The strategy concentrates on identifying and expanding affordable, effective interventions for women who are geographically and culturally isolated--thereby most vulnerable to obstetric tragedy.
Primary beneficiaries include pregnant and postpartum women and their newborns in developing countries. Secondarily, the women's families, their other children, and their communities will benefit from safe delivery and healthy outcome of pregnancy.
Key Results: A medically trained birth attendant who is skilled in safe delivery and treatment of obstetric and newborn complications is essential for improving pregnancy outcome. Over the past five years, there has been a gradual gain in the key indicator of medically-trained attendance at birth -- from 44.7% in 1996 to 48.0% in USAID-assisted countries in 2000 (slightly higher than the target of 47.2%). However, the global figure does mask some regional differences. Notably in the Africa region, skilled attendance continues to stagnate. The Asia and Near East and the Latin America and Caribbean regions have shown good improvement; in the Europe and Eurasia region improvement is slower but it starts from a higher base. While continuing current program direction in other regions, we will focus in the coming year on improving strategies for investing in Africa.
In research and evaluation during FY 2000, the Center achieved the following: (1) improved guidelines for managing pregnancy induced hypertension (PIH), which resulted in no PIH deaths, a 77% decrease in hospitalization and an 87% reduction in costs of care due to PIH in Tver Oblast, Russia; (2) an increase in patient satisfaction from 58% to 87%, better compliance with national essential obstetric care standards from 3% to 83%, and reduction in maternal deaths from 10 to three as a result of communication of clinical standards and associated midwifery training in a district of Nicaragua; and (3) the finding in Nepal that weekly vitamin A supplementation virtually eliminated the four-fold excess mortality of women with night blindness in pregnancy that had been found in the two years following childbirth.
In the policy area, USAID sponsored in collaboration with Pan American Health Organization (PAHO) and the World Health Organization (WHO), a conference which focused on improving maternal care by assuring the capacity of health care providers and facilities through licensing, certification and accreditation. The Center also helped improve commodity procurement in Kenya and influenced funding levels by donors in Zambia. Almost 50 countries implemented the Maternal and Neonatal Program Index, developed in FY 1999, which provides cross-country comparisons on 14 key components of maternal health services.
In community mobilization activities, the Center working through programs such as The Global White Ribbon Campaign, now including 159 member organizations, committed to building advocacy for safe motherhood, helped expand numerous advocacy campaigns to empower communities and foster culturally appropriate approaches. An example of program success was upping the caloric intake of pregnant and lactating women in Bihar by increasing consumption of a corn soya blend, a major dietary supplement, from 12% to 56%, now expected to reach 8.5 million beneficiaries.
In maternal health services, the Center helped achieve the following results: (1) strengthened integrated community participation and improved service delivery programs for pregnant women in South Kalimantan, Indonesia where skilled attendance at birth grew from 37% to 58%; (2) in seven health districts in Bolivia, skilled attendance at delivery jumped from 14% to 24%; (3) a program to assist traditional birth attendants in Guatemala led to an increase in referral for postpartum care from 1% to 20% along with greater use of professional providers for postpartum care (7.5% to 39%); (4) capability for regional outreach was established in Burkina Faso (for West Africa), Uganda (for East Africa) and Guatemala (for LAC) through development of model training centers, preparation of master trainers, updated curricula for health providers, and workshops to promote evidence-based practice.
Performance and Prospects: In the coming years the Center plans to continue its research on the effect of vitamin A and the cost-effectiveness of various intervention packages to improve pregnancy outcome. The cross-national maternal and neonatal performance index that has now been completed in 49 countries will stimulate considerable national policy dialogue about the best way to achieve gains in maternal and neonatal health. We anticipate use of innovative social mobilization activities to foster safe motherhood programs and more effective programming approaches to achieve targeted behavior change--particularly use of skilled attendants at birth. Additional training centers for obstetric and neonatal care will be established and improved, and priority will be placed on improving pre-service curricula to ensure sustainable national scale-up of training. Institutionalization of quality assurance will be emphasized to expand and sustain accomplishments.
Possible Adjustments to Plans: The Center is placing more emphasis on skilled attendance at birth. Additionally, it wants to leverage more resources by partnering with other donor agencies and multilateral organizations.
Other Donor Programs: WHO, UNICEF, UNFPA, PAHO, The World Bank, non-governmental organizations, other bilateral donors, especially the U.K.'s Department for International Development and Japan International Cooperation Agency, have been traditional partners. Increased effort will be made to partner with private foundations, including the Gates and UN Foundations.
Principal Contractors, Grantees or Agencies: JHPIEGO Corporation, Academy for Educational Development, Johns Hopkins University, University Research Corporation, Abt Associates, and WHO are key partners in the areas of research, policy, behavior change and service delivery.
Selected Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY01 (Plan) FY02 (Plan) Indicator Percent of recent live births attended by medically trained personnel. NA 45.7 46.5 48 48.9 49.7 Indicator Effective and appropriate maternal health and nutrition and approaches disseminated NA NA 25 19 5 6 Indicator Maternal and Neonatal Program Effort Index (MNPI) 45* NA NA 56 NA NA Indicator Information
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: S Percent DHS and CDC RHS: denominator - US Bureau of the Census, BUCEN database Number of live births attended by medically trained personnel (doctors, nurses, or midwives but not trained TBAs) per 100 live births Indicator 2: S # of studies All cooperating agencies receiving S02 funds Number of approaches or interventions currently under study. To be counted, the activity must have a hypothesis under study and a protocol guiding the conduct and methodology of the research activity. Indicator 3: S Average composite score Standard questionnaire completed by 10-25 key informants per country The MNPI is a composite score (0-100) derived for each country on 81 items grouped into 13 categories that assess national level of effort toward the treatment of serious pregnancy complications, access to services, maternity and neonatal protocols, and support systems such as funding, personnel, equipment, training, health education and evaluation. The composite scores for each of 50 countries with PHN activities are summed and the average score across countries is reported in the tables. N/A U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 19,808 DA 19,808 DA 0 DA 38,791 CSD 22,103 CSD 16,688 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 0 DA 16,150 CSD 15,103 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 19,808 DA 19,808 DA 0 DA 54,941 CSD 37,206 CSD 17,735 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 1,645 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 14,444 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 16,089 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 19,808 DA 14,400 CSD 143,155 CSD 228,585 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
