Goal and purpose
The SSMP logical framework (see under resources section, SSMP programme documents) was based on and directly supported the national safe motherhood programme long term plan (2006-17) logical framework, with the shared goal of:
Improved maternal and newborn health and survival especially of the poor and excluded
And the shared purpose to:
Help improve safe motherhood and newborn health services and their utilisation particularly for poor and socially excluded
Policy development and planning
SSMP/Options worked with national and international partners to strengthen government capacity in joint planning and review processes and promote evidence based decision making and policy development, incorporating global evidence and national experience into key documents such as:
- The revised National Safe Motherhood and Newborn Health Long Term Plan, 2006-17
- The 2006 National Policy on Skilled Birth Attendants, 2007 In-Service Training Strategy for Skilled Birth Attendants and 2009 Pre-Service Education Strategy for Skilled Birth Attendants
- The 2006 revised National Safe Blood Policy
- The 2007 Strategy for Planned Maintenance of Health Buildings
- The 2009 Human Resources Strategy for Safe Delivery
- The 2009 Gender Equality and Social Inclusion Strategy
- Maternal Incentives for safe Delivery (2005) and Free Delivery Care (2009) – Aama Programme
- The 2009 Remote Area Guidelines
Equity and access
Objective of the Equity and Access Programme
Individuals, groups and networks socially empowered to practise desired safe motherhood and newborn health behaviours leading to increased equity of and access to health services
The SSMP Equity and Access Programme, in partnership with ActionAid, addressed social attitudes and practices that act as barriers to women accessing the care they need. The programme worked in selected areas of eight districts at community and district level. At national level SSMP/Options and JHU/CCP worked with the National Health Education Information Communication Centre (NHEICC) to:
- Advocate for social inclusion and rights issues
- Standardise the technical content of safe motherhood and newborn health messages
- Develop and localise communication materials, such as posters, leaflets, radio and video programmes and non formal education guides
- Help communities in the selected working areas to learn about safe motherhood and newborn health issues, establish local transport schemes and emergency funds, and build links with health facility management committees. Working areas and partners were selected on the basis of need, with a strong focus on social inclusion.
- Capture and use the “voice” of communities and service providers for advocacy and service improvement.
“The emergency fund saved our daughter-in-law from death”
In-laws of a young woman in Rupandehi district who had complications with her first pregnancy. The emergency fund enabled this poor family to take her to the hospital, where she was finally able to give birth safely.
To increase access, SSMP also supported implementation of an innovative national Safe Delivery Incentives Programme to reduce the cost barriers to women accessing safe motherhood care. The scheme provides an incentive to women who deliver in a health facility, to help them meet their travel costs. There are also incentives for health service providers. It was initiated by the government in 2005 and incorporated with Free Delivery Care to become the Aama Programme in 2009. Already there indications that more women are choosing to deliver in a health facility as a result of this.
- Women in the Tarai receive Rs.500
- Women in the hills receive Rs.1,000
- Women in the mountains receive Rs.1,500
Strengthening safe motherhood and newborn health services
SSMP/Options worked at national level with the Family Health Division and other partners to develop and implement national quality standards and promote integrated safe motherhood and newborn health services, including emergency obstetric care and expansion of local 24-hour delivery services. This work has included:
- A national Essential Maternal and Newborn Health Care Package
- A district level Maternal and Newborn Health Need Assessment Tool Kit
- A “software package” based on appreciative inquiry techniques, designed to enable local health facility management committees to take responsibility for improving their services
- The national safe abortion programme, supported in partnership with Ipas, through which services (either public or private) are now available in all 75 districts.
Safe abortion services
“My husband’s job is not well paid, so we cannot afford more children …. I will definitely recommend friends to use this service if they have an unwanted pregnancy”
Client at the safe abortion unit at the Maternity Hospital in Kathmandu. Married with two children, one of whom is disabled, she did not feel able to care properly for another child
In selected districts, SSMP implementing partners, UMN and UNICEF, worked with local stakeholders, including district health offices, government line agencies, health facility management committees and service providers to improve health facility management and quality of services.
Human resource development
Without trained and motivated staff there can be no services. The main focus of SSMP/Options support in staff training was working with the National Health Training Centre and other partners to produce Skilled Birth Attendants and provide other safe motherhood related training, such as operation theatre techniques and management, anaesthetics assistance and comprehensive emergency obstetric care. SBAs are doctors, nurses and auxiliary nurse midwives with specialised midwifery training in the management of deliveries in a facility or at home and referral of cases with complications to a higher centre. SSMP/Options supported the development of training curricula and materials and a five-year operational plan to train 5,000 SBAs - a massive undertaking.
Objective of the National Skilled Birth Attendance Policy
To reduce maternal and newborn morbidity and mortality by ensuring availability access and utilisation of skilled care at every birth.
Information and monitoring
SSMP worked with the Health Management Information System Unit and Family Health Division to ensure the national monitoring system supports programme needs and key information is analysed and disseminated effectively. Critical areas of support were:
- Revision of the health management information system and tools to include emergency obstetric care monitoring and safe abortion service utilisation and ensure data is disaggregated by gender, caste and ethnicity to support social inclusion efforts
- Development and piloting of an integrated Health Sector Information System
- The 2008/09 Maternal Mortality and Morbidity Study
- Promotion of prioritised research in safe motherhood and newborn health.
Physical infrastructure and equipment
SSMP supported the Department of Health Services and Department for Urban Development and Building Construction to plan and implement programmes for health facility infrastructure development (construction and renovation) and supply of equipment and drugs, including:
- Prototypes and standards for the design of various levels of facility, from hospital to health post and including such as basic or comprehensive emergency obstetric care centres or birthing centres
- Participatory need based planning for health facility development, working with local stakeholders and technical experts
- A national database of facilities as the basis for rational infrastructure planning and a maintenance strategy.