1. Improving of maternal and neonatal health Prof d-r Elizabeta Zisovska

2. Approaches on national level Establishment of a National team for CRMD and RNMC is the crucial process, because: 1.There are only few cases of maternal deaths, and unknown number of NMC, so both methodologies should be applied in the same time 2.Few steps are already in place (CG, Safe motherhood committee, State center for RH) 3. Expected valuable information and recommendations in terms of clinical practice and improvement through introduction of CG and protocols 4. Expected good source of information for further training of medical professionals involved in clinical practice

3. Critical issues needed to address in the process of implementation 1. Independence of the above mentioned National team 2. Multidisciplinary approach 3. Period of time to strengthen the role of professional associations 4. Acquiring assurance of complete confidentiality 5. Ensuring trust from the medical professionals involved in the clinical cases that should be reviewed

4. Key lessons to learn: 1 High importance of multidisciplinary approach 2 There are many challenges when new processes are to implement 3 The time is an important factor until success is achieved 4 Transparent information to as many relevant professionals and institutions as possible 5 The importance of re-audit of any clinical audit on National level (check for implementation)

5. Initiatives for improvement of maternal and neonatal health The most successful initiatives that could help improve the quality of care provided by our health services could be: 1Advocate for the initiative (MoH, SMC, Prof. asoc. media) 2.Organize National workshop to introduce BTN and methodology (address governance&leadership, TORs…) 3.Establish National team (Council, WG, etc) for CRMD and RNMC 4.Strengthen the role of the SCRH 5.Develop AP for methodology and implementation in line with initiatives in the field of maternal and neonatal care 6.Introduce appropriate EB Guidelines 7.Conduct appropriate training for HC professionals (raising the awareness for the importance of the BTN concept) 8.Monitoring and evaluation of the implementation

6. Possible barriers: 1Current process of adopting and translation of CG 2Resistance of the HC professionals for implementing changes 3No reliable data (recording and reporting) for inpatient morbidity and mortality 3Defining roles and responsibilities of relevant institutions 4Financial constraints? 5Harmonization of the National policies in terms of maternal and neonatal health (new rulebooks, revisions, etc)

7. Methods of achievements 1.Use the power/authority of the current Committee for safe motherhood, already established by the Government, for the relevant initiatives in terms of endorsement of the BTN concept 2.Establish administrative regulative framework for CG development/adoption/implementation/monitoring (show case revision of CG for PPH as the major cause of maternal death) 3.Create appropriate database, to achieve reliable data 4.Continuous training of medical professionals 5.AP to include budget implications from existing sources/new sources 6.Round table discussions/presentations for relevant institutions/organizations 7.Include the BTN concept within the National strategy (SRH/SM)

8. Monitoring of the implementation process 1.Written approval for the BTN concept 2.Included concept within the Strategy 3.National team established 4.Set predefined milestones and indicators (actions, CG implementation, statistical data…) 5.Define regular monitoring 6.Define audit/re-audit cycle