Earlier this month, global health experts (and students aspiring to be experts) from around the world gathered for a series of presentations, panels and posters at the 2017 Consortium of Universities for Global Health (CUGH) Conference in Washington, D.C. The panel titled “Perspectives on Monitoring Progress Toward Ending Preventable Maternal Mortality: What Measures Matter?” provided an opportunity to discuss the monitoring framework developed to accompany the Strategies toward ending preventable maternal mortality (EPMM) report released in 2015. The panel was moderated by Mary Ellen Stanton, Senior Maternal Health Advisor at USAID, and included Rima Jolivet, Maternal Health Technical Director of the Maternal Health Task Force, Elahi Chowdhury of icddr,b (Bangaldesh) and Chibugo Okoli of the Maternal Child Survival Program (MCSP, Nigeria). Representing maternal health monitoring at the global, national and facility-levels respectively, the panelists provided insights from their unique perspectives and highlighted the importance of the EPMM monitoring framework.
Dr. Jolivet, who co-chaired the process to develop the monitoring framework, began with a brief history of the development of the EPMM strategies and targets and the important role the EPMM Strategies report plays in making sure that maternal health remains a priority in the global monitoring architecture set forth by the Sustainable Development Goals (SDGs) and the Global Strategy for Women’s, Children’s, and Adolescents’ Health 2016-2030 (Global Strategy). She briefly reviewed the global and national maternal mortality rate (MMR) targets and described the iterative, country-driven processes that were used to develop the two sets of indicators that will help countries track progress toward ending preventable maternal mortality.
12 indicators that address the proximal causes of maternal death and establish a minimum data set for reporting by all countries
25 indicators and 6 stratifiers that address the distal causes (social, economic and political determinants) of maternal death, providing a supplemental set of indicators for countries to track progress in specific areas of need
Next, Dr. Okoli outlined the current state of maternal health and service provision in Nigeria and described some of the challenges she and her team face as they work in facilities to implement improvements in readiness and quality of care for maternal health services. Dr. Okoli noted that in the Nigerian context, where several of MCSP’s efforts focus on improvements in the supply chain for obstetric care and the number of women who deliver with the assistance of a skilled birth attendant, the EPMM phase I/proximal indicators are particularly helpful for tracking progress across facilities.
Dr. Chowdhury then described the state of maternal health and maternal health services in Bangladesh, as well as some of the challenges women face in receiving maternal health care there. Dr. Chowdhury, who has been involved with the process to develop a monitoring framework for EPMM since its inception, highlighted both the EPMM Phase II/distal indicators that Bangladesh is already monitoring and the indicators that could benefit from further attention.
Following the presentations, the panel engaged in a guided discussion led by Ms. Stanton about how the EPMM framework complements other global maternal health monitoring frameworks—including the SDGs, the Global Strategy, Countdown to 2030 and the WHO Quality of Care Network—and how the 11 key themes from the EPMM strategies report resonate in different countries and contexts. The audience was then given the opportunity to raise additional questions, a number of which were related to the issue of delays women experience in seeking and receiving maternal health care.
Dr. Okoli noted that in Nigeria, the delay tends to occur during the care-seeking phase. To combat this delay and ensure maternal health care is a priority for all women, mechanisms like community health workers and a national agency in charge of prevention of mother-to-child transmission of HIV outreach create the link between women and communities and the local health facilities. EPMM indicators on community participation are particularly relevant in this context. Dr. Chowdhury added that in the Bangladeshi context, however, a shortage of human resources—especially clinicians in rural areas—means that women often experience significant delays during the care-receiving phase. In this case, EPMM indicators on the distribution of the clinical workforce are ideal. The different applications of the EPMM indicators in Nigeria and Bangladesh demonstrate why the EPMM strategies, targets and monitoring framework were developed with a significant amount of country input: Each country has different needs, and a monitoring framework that takes this into account is more likely to be adopted by and helpful to national stakeholders. Dr. Jolivet described this approach as “collaborative development and deployment” and noted that input from country stakeholders resulted in the EPMM Phase II indicators on the more distal social and systemic determinants of maternal health being presented in a menu format, or pick-list, from which countries can select the indicators that are best suited to their unique issues in maternal health.
Overall, the panel was an interesting and lively look at how country decision makers can decide what measures matter most when it comes to tracking progress in maternal health. The mix of perspectives—both in the level of tracking (global, national, facility) and geography—gave the audience a chance to better understand the unique and important role the EPMM monitoring framework can play in helping to achieve progress toward the maternal health goals set forth by the SDGs and the Global Strategy.
Read the Strategies toward ending preventable maternal mortality (EPMM) report.
Check out an interview with Rima Jolivet, MHTF’s Maternal Health Technical Director, on the role of midwifery in ending preventable maternal mortality.
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