National Needs Assessments for Emergency Obstetric and Newborn Care
Emergency services for women and newborns
Access to emergency obstetric care (EmOC) in high-income countries has helped to ensure that pregnancy and childbirth are no longer major threats to the lives of women and newborns. But in most low- and middle-income countries this is not the case. Their health systems still fail to provide widespread access to this life-saving solution. As a result, 99% of all maternal deaths occur in the developing world.
Making change: Evaluating emergency services for women and newborns
Why the "N" for newborn in EmONC Needs Assessment?
You’ll notice that throughout most of our website we use "EmOC" instead of "EmONC" to refer to emergency care during pregnancy and childbirth. But, we use "EmONC" in the title of our Needs Assessment. We added the "N," which stands for newborn, to emphasize that our Needs Assessment collects detailed information on emergency services for newborns as well as mothers.
AMDD works with national ministries of health and United Nations (UN) partners (UNFPA, UNICEF, and WHO) to carry out national Emergency Obstetric and Newborn Care (EmONC) Needs Assessments that evaluate how well and to what extent the health system is providing EmOC. These Needs Assessments go a step further to provide details for planning to address gaps or problems in EmOC services.
This is a first and critical step to improving equitable access to EmOC and to strengthening the overall health system.
Since 1999, AMDD has provided technical expertise in developing the EmONC Needs Assessment. We also lend technical expertise to the countries that conduct them.
Promoting a practical tool to strengthen access
Results on the ground: Ethiopia
In Ethiopia, the 2009 Needs Assessment revealed that an inadequate water supply was in part preventing facilities from providing quality EmOC. In response, UN agencies helped the country develop a strategy to provide water to all facilities without running water.
The process and tools developed by AMDD and its UN partners help countries map concrete actions to improve availability, quality, and utilization of EmOC. The Needs Assessment is an extremely practical planning and monitoring tool that helps governments understand what is happening inside health facilities at that very moment. It examines why women and newborns are dying – and not just how many – which is essential for successfully implementing change to the health system. Click here for articles published using the results of the Ethiopian Needs Assessment.
Results on the ground: Angola
In Angola, the 2007 Needs Assessment results showed that certain regions had a much lower maternal death rate from the obstetric complication eclampsia. After further investigation, Angola determined that these areas had better access to the anti-convulsant magnesium sulfate, knowledge useful for improving the region's EmOC services.
The Needs Assessment is a survey of health facilities (health centers and hospitals) throughout the country that helps answer questions such as:
- Are there enough facilities providing EmOC?
- Do facilities have adequate numbers of health workers with the right mix of skills?
- Are the right women, meaning those with obstetric complications, using the facilities?
- Is the quality of the service adequate?
Results on the ground: Uganda
After AMDD helped conduct a 2003 national Needs Assessment in Uganda with UNICEF, EmOC was prioritized into the national health plan.
The Needs Assessment also covers much more than EmOC; it includes other areas of reproductive health such as non-emergency obstetric care, prenatal care, family planning, infection prevention, and HIV prevention, care, and treatment.
Upon request, AMDD works with ministries of health and UN partners from the very beginning of the process – from shaping Needs Assessment methodology to training data collectors, analyzing data, writing and disseminating reports, and planning post-Needs Assessment implementation and action.
How Needs Assessment results make a difference
After our first five years, a 2004 Gates Foundation-sponsored evaluation had this to say about our Needs Assessment work: "The Needs Assessments were instrumental in convincing governments and donors to incorporate EmOC into national health programs."
National and district health officials use the Needs Assessment data to guide policy, planning, and budgeting to strengthen the health system and improve EmOC services. For example, the data directly impact program planning by showing unacceptably low levels of EmOC utilization, identifying areas within the health system that require particular attention. At the national policy level, government officials have assigned higher priority to emergency services for women and newborns based on Needs Assessment data.
After helping conduct Needs Assessments, AMDD has directly assisted 23 governments in developing national programs to improve emergency obstetric care.
Needs Assessment resources
Visit our technical resources page for tools and guidelines on conducting Needs Assessments.
Download our Needs Assessment fact sheet in English and French here.
Filling a gap: Why has AMDD tackled Needs Assessments?
When AMDD began in 1999, there was less global consensus on strategies for reducing maternal and newborn death. AMDD became an early advocate of EmOC. Today, most agree that access to EmOC, family planning, and skilled attendance at birth are essential parts of any strategy.
Along with this ground-breaking shift in thinking came the need to assess the ability of health systems to deliver EmOC. Few guidelines or tools existed. Building on previous work at Columbia University where AMDD is based, the program developed the EmONC Needs Assessment. This, along with other practical and adaptable tools, helped to evaluate the current state of EmOC internationally and define the path forward.
Since then, AMDD and its UN partners have continued to refine and improve the EmONC Needs Assessments. Today the world increasingly recognizes that the value of Needs Assessments extends beyond EmOC. Improvements based on Needs Assessment not only strengthen EmOC services but many other parts of the health system as well.
Where we’re currently working in EmONC Needs Assessments
- Benin
- Burkina Faso
- Burundi
- Chad
- Cote d’Ivoire
- Democratic Republic of Congo
- Ghana
- Guyana
- Laos
- Liberia
- Malawi
- Mali
- Niger
- Republic of Congo
- South Sudan
All part of a larger health system
Facilities must be prepared to deliver high-quality EmOC when needed, but there are many other pieces of the health system that must come together to ensure access to life-saving emergency obstetric care for all women and newborns. Learn about our work in: