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EmOC indicators/measurement

Maternal and newborn health national plans (Road Map) Assessment (UNFPA, 2012)

Evaluating the quality of care for severe pregnancy complicationsThe WHO near-miss approach for maternal health (WHO 2011)

Needs Assessment of Emergency Obstetric and Newborn Care: Data Collection Modules.  AMDD, Columbia University. 2010. Also available in Français

Monitoring emergency obstetric care: a handbook. World Health Organization, UNFPA, UNICEF, AMDD. 2009. Also available in Français

Earlier editions of the handbook:

Guidelines for monitoring the availability and use of obstetric services. UNICEF, WHO, UNFPA. August 1997. Also available in Français and Español

A tool for assessing "readiness" in emergency obstetric care The room-by-room "walk-through" (AMDD, 2005)

Using the U.N. process indicators of emergency obstetric services: questions and answers. AMDD, Columbia University. 2003. Also available in Français and Español

Reducing maternal deaths: selecting priorities, tracking progress. Distance learning courses on population issues. UNFPA and AMDD. 2002.


Clinical training

Guidelines for In-Service Training in Basic and Comprehensive Emergency Obstetric and Newborn Care(JHPIEGO, 2012)

A Handbook for Building Skills: Counseling for Maternal and Newborn Healthcare (WHO, 2010)

EmONC Training Curricula Comparison. AMDD. May 2010. Includes comparison of curricula and tools to support training.

Prise en charge des complications de la grossesse et de l'accouchement : guide destiné à la sage-femme et au médecin. OMS, UNFPA, UNICEF, Banque Mondiale. 2004.

Guidelines for Assessment of Skilled Providers after Training in Maternal and Newborn Healthcare (JHPIEGO, 2004)

Anesthesia for emergency obstetric care: course handbook for trainers and participants. JHPIEGO and AMDD. 2003. Includes assessment tools, follow-up guide, and log books. Also available in Français (Guide des Participants, Guide des Formateurs, Listes de Vérification, Conseils pour les Formateurs, Registre de l’Expérience Clinique)

Infection prevention practices in emergency obstetric care. A supplement to Infection Prevention: A Reference Booklet for Health Care Providers. EngenderHealth and AMDD. 2003. Also available in Français and Español

Emergency obstetric care for doctors and midwives: course handbook for trainers and participants. JHPIEGO and AMDD. May 2002.  Includes assessment tools, follow-up guide, and log books. Also available in Français (Guide des Participants, Guide des Formateurs, Listes de Vérification, Conseils pour les Formateurs,Registre de l’Expérience Clinique)

Manejo de las complicaciones del embarazo y el parto: guía par obstetrices y médicos. OMS, UNFPA, UNICEF, Banco Mundial. 2000, 2002.

Managing complications in pregnancy and childbirth: a guide for midwives and doctors. WHO, UNFPA, UNICEF, World Bank. 2000.


Quality improvement

Quality improvement for emergency obstetric care: leadership manual and toolbook. An adaptation of COPE® EngenderHealth and AMDD. 2003. Also available in Français, and Español.

Improving emergency obstetric care through criterion-based audit. AMDD and Columbia University. 2002. Also available in Français, and Español.


Program planning

Ten Good Practices in Essential Supplies for Family Planning and Maternal Health (UNFPA, 2012)

Program Implementation Guidance: Essential Obstetric and Newborn Care (USAID & MCHIP, 2012)

District Planning Tool for Maternal and Newborn Health Strategy Implementation:A Practical Tool for Strengthening Health Management System (WHO, 2011)

Essential Medicines for Reproductive Health: Guiding Principles for the Inclusion on National Medicines Lists (WHO, UNFPA, PATH, 2006)

Course 6: Reducing maternal deaths: selecting priorities, tracking progress. Distance learning courses on population issues.  UNFPA, AMDD, Columbia University. 2002. Also available in Français and Español

The design and evaluation of maternal mortality programs. Maine D, Akalin M Z, Ward V M, Kamara, A. Center for Population and Family Health, Mailman School of Public Health. Columbia University. June 1997. Also available in Français and Español

Safe motherhood programs: options and issues. Maine D. Prevention of Maternal Mortality Program. 1993. Also available in Français and Español


Human resources for health

WHO Recommendations: Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions through task-shifting (WHO, 2012)


Systems thinking - background pieces

Galea et al. (2010) "Causal thinking and complex system approaches in epidemiology"

de Savigny & Adam (2009) Systems thinking for health systems strengthening

Sterman (2006) "Learning from evidence in a complex world" (this article provides examples of policy resistance and offers an introduction to simulation modeling)

Chapman (2004) System failure: Why governments must learn to think differently"

TED Talk Eric Berlow: How complexity leads to simplicity" (a quick, 4-minute presentation about complex systems)


Maternal referral - Overview, country and district-level studies

Awoonor-Williams (2010) "Transportation and referral for maternal health within the CHPS System in Ghana" (presentation)

Holmes & Kennedy (2010) Reaching emergency obstetric care: Overcoming the ‘second delay’ (a briefing paper from Compass: Women's and Children's Health Knowledge Hub )

Iyengar & Iyengar (2009) "Emergency obstetric care and referral: Experience of two midwife-led health centers in rural Rajasthan, India"

Kruk et al. (2009) "Bypassing primary care facilities for childbirth: A population-based study in rural Tanzania"

Kruk et al. (2009) "Women’s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment"

Medical Services Directorate, Federal Ministry of Health, Ethiopia: "Patient referral implementation guideline."

Murray & Pearson (2006) "Maternity referral systems in developing countries: Current knowledge and future research needs" (a review article describing the core elements of a maternal referral system and major knowledge gaps)

Gaym (2000) "A review of maternal mortality at Jimma Hospital, Southwestern Ethiopia"

Gaym (2000) "Perinatal mortality audit at Jimma hospital, South-Western Ethiopia, 1990-1999"


Newborn referral

Darmstadt et al. (2010) "Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral"

Waiswa et al. (2010) "Using the three delays model to understand why newborn babies die in eastern Uganda"

Lee et al. (2009) "Linking families and facilities for care at birth: What works to avert intrapartum-related deaths."


Tools and metrics - studies and resources

UNICEF (2010) "Operating perinatal referral transport services in rural India" (A toolkit)

Partnership Defined Quality (PDQ) resources from Save the Children:

Iiams-Hauser et al. (2010) "Utilizing SMS to improve the continuum of care for HIV positive pregnant women and HIV exposed children: The PMTCT Module" (poster; email Allegra for pdf)

Millennium Villages Project:

Strand et al. (2009) "Audit of referral of obstetric emergencies in Angola: A tool for assessing quality of care"

Geographic Information Systems (GIS) applications for referral and health systems:

Murray et al. (2001) "Tools for monitoring the effectiveness of district maternity referral systems"


Transportation and road infrastructure - studies and resources

Giovine & Ostrowski (2010) "Improving transportation and referral for maternal health: Knowledge gaps & recommendations" (A technical report from the Improving Transportation and Referral for Maternal Health Meeting hosted by the Woodrow Wilson International Center for Scholars and convened by the Maternal Health Task Force and partners)

Transaid's technical case studies:

Geleso Borrie (2010) "The role of road infrastructure in improving rural health solutions"

GVK Emergency Management and Research Institute (EMRI)

See eRanger Production Company's resources on this issue, too.