The Bank identifies improving maternal health as a corporate priority. We also understand that to improve maternal health, it is necessary to think multisectorally with the Pathways approach, as factors that lead to poor maternal health are broad and require improvements in a range of other issues, such as education, gender equity, health systems, and roads.
There are a variety of strategies and approaches that have shown positive results in improving the access women, especially poor women, have to basic maternal health services.
1. Strengthening Outreach Services and Community Based Approaches: Sensitize communities on safe motherhood and develop alternative outreach strategies that take the MCH services to the poor women in their homes through community based skilled birth attendants, mobile teams for prenatal and EPI, community-based distribution of contraceptives, maternity waiting homes and rural midwifery programs. Sri Lanka and Malaysia successfully reduced maternal mortality in a relatively short time because of increased community outreach through a national network of health centers.
2. Improving Education for Girls and Women: Provide knowledge and education about maternal health to women and their families to promote better health-seeking behaviors. Improve access to education for girls of poor families in order to delay early child bearing and improve women's empowerment. Korea, Thailand, and India (Kerala and Tamil Nadu) are examples of countries that have invested in girls’ education and have improved maternal health outcomes.
3. Targeting public sector subsidies to poor families and disadvantaged areas: Poorer areas will need more financial and human resources to improve accessibility and improve quality of services. Mexico's Programa Nacional de Education, Salud y Alimentation (PROGRESA) has improved service utilization by providing monetary assistance, education health services and nutritional assistance to poor women. The transfer of money to women has improved their status and decision making power over their health. Introduce community-financing schemes. Promote private services for those who can afford it and assure public funds are used to finance transportation and care for the poor. Bolivia's National Insurance Program for Mothers and Children provides covered services for maternal and newborn care.
4. Developing Effective 'poor-friendly' Referral Systems: Sensitize communities and private sector on their roles. Improve communication (roads and telecommunication) in rural, poor areas. Strengthen partnerships between traditional birth attendants and skilled formal providers; build linkages with other reproductive health, nutrition, gender and adolescent health interventions. Cuba built a strong referral system and established maternity waiting homes for rural women.
5. Improving Quality and Availability of Essential and Emergency Obstetric Care services (EOC) for the Poor: Strengthen policies and capacity building, training of providers for improved quality of care, availability of drugs, equipment and supplies and improve logistics. Ensure availability of emergency care services that also include EOC. India pays additional incentives to providers to provide twenty-four hour EOC and provides transport subsidies to poor women seeking EOC. The Regional Prevention of Maternal Mortality Network (RPMMN) in Africa has shown that this can be done within existing resources from communities, government and the private sector.
6. Promoting Affordable Maternal Health Services. Scale up Adolescent Sexual and Reproductive Health Information and Services: Provide information and services for different age groups and for both in-school and out-of-school programs; improve girls participation; and broaden them to include recreation and livelihood activities. Jamaica has a successful program for reducing unwanted pregnancies among adolescents.
7. Strengthening Monitoring and Evaluation: Identify appropriate indicators and tools that will provide information on the poor; eg. differentiated process indicators (availability of EOC services, deliveries by skilled attendants by income group) maternal audits at health facility and community level, and Reproductive Age Survey (RAMOS) where vital registration is good. Conduct benefit-incidence analysis. Honduras has introduced maternal mortality epidemiological surveillance based on CDC/PAHO guidelines. IMMPACT will be strengthening selected countries' capacity in monitoring and evaluation.