To date, the focus of safe motherhood programs in most countries has been on the delivery of maternal services other than emergency obstetric care (EOC). However, maternal mortality rates cannot be reduced unless prompt adequate care is available for obstetric complications. This report outlines the barriers to timely and appropriate EOC in Africa, and reviews lessons learned and best practices for improving EOC; the cost of EOC and research needs and information gaps are also addressed.
A number of interventions that can help establish an effective EOC capability in Africa are identified. These include: providing community education and mobilization, establishing community loan funds for those who would not otherwise seek health care, training traditional birth attendants in obstetric first aid, and increasing the availability of emergency transportation as well as the number of community-based Maternity Waiting Homes (MWHs). Other recommendations are to: increase the training and delegated authority of midwives, an important community resource; boost health worker morale by ensuring the availability of basic supplies and by providing on-the-job training, feedback, and supervision; establish revolving drug funds to ensure consistent drug supplies at health facilities; make drug prices commensurate with system sustainability (mark-up must cover defaulters); and improve the quality of existing EOC services at the health facility level. Additional recommendations include: developing formal linkages between community-level health service providers and EOC facilities; identifying optimal financing methods in different settings, especially where a significant number of private sector providers exists; and advocating the cause of EOC by disseminating findings from evaluation/research activities to donors, program managers, and policymakers. Includes references.
