ASSESSING THE MATERNAL HEALTH
SITUATION
When designing a maternal health program, one needs to examine the
magnitude and causes of maternal death, the level of infrastructure,
accessibility and use of health services, and other efforts to address this
problem. In addition, there should be an environmental analysis to
understand the role of government, private providers and NGOs in the
area, and what donors are supporting to foster effective partnerships.
This section describes several ways to collect maternal health data
including some questions to use when appraising the maternal health situation
in a specific context and a framework to analyze the data.
A. Environmental Assessment
An environmental assessment, a broad review of the operating environment,
can be done as part of data collection, or it can be done initially
to get a sense of the situation and then done more in-depth during the
data collection phase. This will depend somewhat on the understanding
of the situation and the secondary data available. For example, it was
easy for CARE in Bangladesh to do an initial environmental assessment
because we have a long history in Bangladesh and there is ample data.
Regardless of when you decide to do the assessment, it is important and
can give valuable insight into where your organization can be the most
effective.
The first step of the assessment is to understand your own organization’s
strengths and weaknesses.
CARE is engaged in a broad-based effort to reduce poverty through programs
in agriculture, natural resource management, income generation,
education, health and emergency relief. These diverse efforts are unified
through the Household Livelihood Security Framework, which is the
organizing construct for CARE’s programming. This holistic approach
helps CARE bring together programs at the household level to work
towards poverty reduction.
A fundamental feature of CARE’s current and future health programming
is the foundation provided by the Health Security Framework. The second step of the
assessment is understanding the essential components
needed for effective programming.
Health security is a useful framework when looking at what essential
components are needed to ensure good maternal and neonatal programming.
In terms of maternal and neonatal health, this means assessment
of the health risk to mothers and newborns utilizing qualitative and
quantitative methods. This data needs to be reviewed in terms of the following
components, which we believe are essential to address the
complex problems of maternal and neonatal deaths.
➔ Optimal health interventions: Experience and research tell us
what are the optimal health interventions, which may be either
preventive or curative, for each major cause of mortality/morbidity.
For example, there have been major advances in our understanding
of the role of emergency obstetrical care in maternal health. Where
effective technical packages exist, then the task is to promote the
use of optimal health technologies. CARE focuses much of its effort
on bringing simple, effective technologies to bear. However, clear
technical solutions are not always apparent; then CARE can play a
useful role in testing alternatives.
➔ Healthy behaviors within the household: Many of the risks experienced
by poor households can be mitigated at low cost through
behavior change at the individual and household level. Maternal
health outcomes could be improved dramatically through increased
use of family planning, and preparing for the possibility of complications
during birth.
➔ Community empowerment: Conventional approaches to improving
health status have focused largely on the supply side (e.g., increasing
the capacity of health providers to deliver services). Community
empowerment can play a key role in behavior change and demand
generation. Of particular importance is strengthening the influence
of community health organizations controlled by women and focused
on the health priorities of women.