Safe Motherhood: A Review - Family Care International

National Programs, Policies,
and Budgetary Commitments for Safe Motherhood
• Procurement of motorized ambulances
• Procurement and installation of radio
communication equipment in health
facilities and ambulances
• Telephone networks, including mobile
phones for central hospitals, and land line
phones for district hospitals and some
health centers
• Development of emergency obstetric case
management protocols, for health centers
and for district hospitals, and orientation of
health care providers on its use
• National Conference on Safe Motherhood
(2001)
• Introduction of PMTCT in 31 health facilities
by 2004
• Research on various aspects of maternal
health, including use of bicycle ambulances;
barriers to utilization of maternity services;
perceptions, utilization, and quality of care
in maternity waiting huts; feasibility and
acceptability of revolving health funds for
emergency medical and obstetric referral
• Assessments on various issues related to
maternal health
Monitoring and Evaluation
While the national safe motherhood
program has not lowered overall
maternal mortality levels in Malawi, it has
achieved some measurable improvements in
the following key programmatic areas:
• Upgrading the training of health care
providers, particularly at the health center
level. Medical assistants have been trained
in maternity care and clinical officers as
anesthetists through an upgraded diploma
course, which includes emergency obstetric
anesthesia and resuscitation of the newborn.
• Influencing policies of professional
regulating bodies such as the Medical
Council and Nurses and Midwives’ Council.
Nurse Midwives were not previously
allowed to perform manual removal of
placenta, or give intravenous oxytocics
or intravenous anticonvulsants. State
Registered Nurse Midwives are now trained
and allowed to perform manual vacuum
aspiration (MVA) for incomplete abortion
and provide postabortion care.
• Increased public awareness on maternal
health issues, through posters, jingles,
dramas, public speeches, etc.
• Increased availability, and to some extent
accessibility and quality, of services
provided in some health facilities,
through building of new health facilities;
refurbishment and renovation of some
dilapidated structures.
• Development of other national policies,
guidelines, etc. to facilitate implementation
of the SM policy and program, e.g.,
PMTCT, Human Resource Development and
Management Policy.
With regard to the quality of obstetric care
services, all assessments and research
reports have shown that it remains very
poor. Many facilities lack basic equipment for
quality obstetric care services such as blood
transfusion, and there is a critical shortage
of health care providers, especially nurse
midwives. 64 The national EmOC assessment
(2005) showed that none of the health centers
could be regarded as a basic EmOC facility as
they did not provide the six signal functions. 65
64 Ministry of Health. “Report on the National Assessment of EmOC.” Lilongwe, Malawi, 2005.; Sangala W.O.O. “Human
Resources for Health in Malawi—Overcoming the Crisis.” Unpublished report. Ministry of Health, Lilongwe, Malawi, 2005;
Ministry of Health. “Report on a Quality of Care Assessment.” Lilongwe, Malawi, 2004. Maclean G.D. “Obstetric Life Saving
Skills in Malawi: An Evaluation.” Lilongwe, Malawi: DFID, 2000.
65 Ministry of Health. “Report on the National Asessment of EmOC.” Lilongwe, Malawi, 2005.