1. Emergency obstetric and newborn care signal functions and health facility capacity: Baseline evaluations of the Saving Mothers, Giving Life pilot districts in Zambia Carla Chibwesha, MD MSc Centre for Infectious Disease Research in Zambia For the Saving Mothers, Giving Life Study Group

2. Acknowledgements The Saving Mothers, Giving Life Study Group thanks: The conference organizers CDC and USAID for funding support Co-authors: Davidson H. Hamer, BU & ZCAHRD K. Cherry Liu, UNC & CIDRZ Michelle Wallon, MCHIP Fatima Soud, CDC Zambia Don Thea, BU & ZCAHRD Namwinga Chintu, CIDRZ Daniel Williams, CDC Fernando Carlosama, CDC James McAuley, CDC Zambia

3. Acknowledgements Ministry of Health Zambia

4. Background Every 60 seconds a woman dies from preventable causes related to pregnancy and childbirth Globally, a woman’s lifetime risk of dying during pregnancy and childbirth is 1 in 180 In Zambia, lifetime risk of death during pregnancy and childbirth is 1 in 27 Zambia’s neonatal mortality rate is 30 per 1,000 WHO, 2012

5. Zambia’s MMR 1990 – 2008 and 2015 MDG target

6. Skilled attendance at delivery by quintile of wealth

7. What skills and services are important? Most maternal deaths occur during labor, delivery, or the first 24 hours postpartum Although most complications can be prevented or treated they cannot be predicted Interventions to treat major direct obstetric complications may reduce maternal and newborn morbidity and mortality

8. Causes of maternal mortality Kahn, 2006

9. Basic EmONC functions 1. Parenteral antibiotics 2. Uterotonics 3. Anticonvulsants 4. Assisted delivery 5. Removal of retained placenta 6. Removal of retained products of conception 7. Neonatal resuscitation Basic functions + 8. Blood transfusion 9. Cesarean delivery Comprehensive EmONC functions

10. Assessment of obstetric and newborn health services in SMGL pilot districts Goals: To obtain accurate information on the availability and quality of maternal and newborn health services To identify gaps in service provision To revise program goals and objectives to reflect realities on the ground Target: 121 health facility is 4 districts 8 hospitals, 94 health centres, and 19 health posts

11. SMGL pilot districts Eastern Province : Nyimba district Lundazi district Luapula Province: Mansa district Southern Province : Kalomo district

12. Assessment tool M1: Identification and infrastructure M2: Human resources M3: Pharmacy services M4: ANC/PNC medications, equipment, and supplies M5: Essential drugs, equipment, and supplies M6: Lab and blood bank services M7: EmONC signal functions M8: Case summaries M9: Community mobilization

13. Facility staffing and availability of electricity, water, communication, and transportation SMGL pilot districts All clinical sites121 Open 24 hours86 (71%) At least one skilled staff member111 (92%) Electricity71 (59%) Water source106 (88%) Functional radio or telephone56 (46%) Emergency transport for referral76 (63%)

16. EmONC services SMGL pilot districts All clinical sites (prior 3 months)121 Administration of parenteral antibiotics 93 (81%) Administration of oxytocics 106 (92%) Administration of anticonvulsants 53 (46%) Manual removal of placenta 45 (40%) Removal of retained products 22 (19%) Assisted vaginal delivery 13 (11%) Neonatal resuscitation 32 (28%) Cesarean sections* 4 (5%) Blood transfusions* 8 (7%) *CEmONC functions

17. Stockouts of EmONC supplies SMGL pilot districts All clinical sites (prior 12 months)121 Parenteral antibiotics 93 (77%) Oxytocics 25 (21%) Anticonvulsants 90 (74%)

18. Conclusion Unmet need for lifesaving obstetric and neonatal care services is substantial Health facilities are not commonly staffed with adequately trained providers Essential EmONC services and supplies are not widely or consistently available A comprehensive, sustainable approach to strengthening human resources, clinical skills, physical infrastructure, and essential supplies and equipment is needed