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Reproductive Health |
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Averting Maternal Death and Disability (AMDD) Program |
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The Averting Maternal Death and Disability (AMDD) Program operates on the assumption that all pregnant women are at risk for serious complications and thus focuses on improving access, utilization and quality of emergency obstetric care. The program prioritizes the preparation and readiness of basic and comprehensive EmOC (emergency obstetric care) facilities, or reducing the "third delay" of the "3 delay model." The first delay occurs in the woman's home when she or those around her fail to recognize that she is suffering an obstetric complication that requires medical attention; the second delay takes place in the process of reaching appropriate care; and the third delay unfolds when she is not promptly diagnosed or treated at the facility. Once services are in place, the program seeks to reduce the first and second delays. The AMDD approach encompasses three facets. Briefly, the technical component focuses on staff acquiring the necessary clinical skills. The managerial component embraces staffing and team building, maintaining a constant supply of drugs and equipment, an information system, IEC, facility maintenance and supervision. Integrated into clinical treatment and facility management are principles of human rights, in which issues such as discrimination, priority setting, information and communication or personal privacy are addressed in program planning and implementation. The AMDD approach, for phase one of the program, includes five stages for improving emergency obstetric care: assess needs for EmOC, plan the program, implement the program, monitor and evaluate, and disseminate information. Programs and partners--AMDD was founded in 1999, with a generous grant from the Bill & Melinda Gates Foundation. It is managed by Columbia University's Heilbrunn Center for Population and Family Health, Mailman School of Public Health. AMDD has established partnerships with organizations that already have field operations. This helps achieve results more quickly and broadly, avoids spending valuable resources to set up separate field infrastructure, broadens the community of agencies dealing with emergency obstetric care, and promotes sustainability. These partners are now implementing over 55 AMDD-supported projects in 39 countries:
Family Health International (FHI) is an important technical partner to AMDD, supplying expertise in maternal health and providing technical assistance to governments and local implementing agencies. Other AMDD technical partners include John Snow International, the Indian Institute of Management at Ahmedabad, Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) and EngenderHealth (formerly AVSC International). Monitoring and evaluation--The desired and expected impact of AMDD is fewer maternal deaths in program areas, although maternal mortality is not being measured directly. To monitor progress, all AMDD projects collect baseline information and information every six months based on six process indicators. The indicators were developed by Columbia's School of Public Health in collaboration with colleagues at United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Known as the "UN Process Indicators", they were issued jointly in 1997 by UNICEF, United Nations Population Fund (UNFPA) and WHO. The indicators evaluate availability and use of obstetric care services:
According to UNFPA, basic emergency obstetric care usually provided in health centers and small maternity homes, should include IV administration of antibiotics, oxytocics, and anticonvulsants; manual removal of the placenta; removal of retained products following miscarriage or abortion; and assisted vaginal delivery with forceps or vacuum extractor. Comprehensive emergency obstetric care, typically delivered in district hospitals, includes basic care plus Cesarean delivery and safe blood transfusion. To manage obstetric complications – the life-saving component of maternity care – a facility must have trained staff, functioning equipment, medical supplies and drugs. Furthermore, facilities must be open and ready to respond to emergencies 24 hours a day, 7 days a week. Existing district hospitals and health centers, with just a few changes, are often capable of providing emergency obstetric care. Program areas--The core of the AMDD program is field projects to improve emergency obstetric care (EmOC). Ensuring availability, quality, and utilization of EmOC services is an on-going process involving: needs assessments, project development, renovating and equipping facilities, training staff and improving management, monitoring and evaluation, and quality of care. To that end, the program looks to strengthen and expand partnerships, provide technical assistance, apply human rights principles and track progress. In addition, AMDD has developed substantive tools to facilitate implementation, replication and sustainability of the projects. The program also supports centers for obstetric fistula repair; acknowledges leadership through grants and awards; disseminates information through journal articles and the website; and fosters a global network of decision-makers and program managers who are focused on EmOC. Resources Averting Maternal Death and Disability Program's Web site publishes a newsletter, AMDD Notebook, reporting on specific issues and projects. United Nations Population Fund A portion of the UNFPA website is devoted to issues of maternal mortality. Excellent source of statistics.
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