Bulletin of the World Health Organization

Tracking maternal mortality declines in Mongolia between 1992 and 2007: the importance of collaboration

Buyanjargal Yadamsuren, Mario Merialdi, Ishnyam Davaadorj, Jennifer Harris Requejo, Ana Pilar Betrán, Asima Ahmad, Pagvajav Nymadawa, Tudevdorj Erkhembaatar, Delia Barcelona, Katherine Ba-thike, Robert J Hagan, Richard Prado, Wolf Wagner, Seded Khishgee, Tserendorj Sodnompil, Baatar Tsedmaa, Baldan Jav, Salik R Govind, Genden Purevsuren, Baldan Tsevelmaa, Bayaraa Soyoltuya, Brooke R Johnson, Peter Fajans, Paul FA Van Look & Altankhuyag Otgonbold

Volume 88, Number 3, March 2010, 192-198

Table 1. Main characteristics of the Maternal Mortality Reduction Strategy 2001–2004 in Mongolia

Objective Examples of activities implemented Responsible parties Financial resources
1. To create a favourable environment for community mobilization and participation to reduce maternal mortality (involvement of district and provincial governors, decision-makers, policy-makers, general public) Mobilize community involvement from the level of district governors to the general public into reproductive health advocacy training, changing attitudes and gaining support. MoH, MCHRC UNICEF, UNFPA, local governments
Organize annual governors’ conferences on the situation of maternal and child mortality and morbidity.
Re-establish maternal waiting homes.
Provide transportation costs for pregnant women between their homes and the maternal waiting homes.

2. To introduce and monitor client-centred services at all levels of the health-care system in order to improve the quality of a comprehensive obstetric care package (involving health-care units at all levels) Establish a clear obstetric and newborn care ackage including antenatal care, and care during delivery and postpartum period. MoH, MCHRC, NUM, HIV/AIDS Centre, WHO, City Health Department, UNFPA, NHDC, PHI, GTZ UNFPA, WHO, GTZ, UNICEF, PHI, MoH, NHDC
Establish clear competencies for health-care units at all levels of the system.

3. To develop standards for a mother and child comprehensive care package and introduce it at all levels of obstetric care Review and revise job descriptions for community health workers, midwives, general practitioners and obstetrician-gynaecologists. MoH, Mongolian Association of Obstetrics and Gynaecology, MCHRC MoH, WHO
Translate, adapt, distribute and implement at all levels the WHO “Managing complications in pregnancy and childbirth” guidelines.
Train at least two trainers in each province on the WHO guidelines and on how to organize training for doctors in districts and villages.
Provide essential drugs to all maternal-neonatal service providers.

4. To organize, in association with the mass media, education activities for families and the public on safe motherhood issues and pay more attention to vulnerable groups in the population who lack access to health services (involving central and local governmental organizations, nongovernmental organizations, donor countries and international organizations, health institutions, press agencies) Develop and implement an information, education and communication (IEC) strategy on safe motherhood. MoH, PHI, NHDC UNFPA, UNICEF, GTZ
Develop high-quality IEC material on safe motherhood and distribute.
Train and improve health workers “safe motherhood” knowledge and skills working in IEC.

5. To encourage and expand participation by nongovernmental organizations and the public in safe motherhood activities (involving central and local governmental organizations and nongovernmental organizations) Educate pregnant women, their families and communities on the signs of pregnancy complications. MoH, MCHRC, Health Department, NGOs UNFPA, UNICEF
Promote maternal waiting homes.
Encourage training for volunteers and their involvement in safe motherhood initiatives.

6. To improve management of safe motherhood services and counselling at all levels Develop and implement a regulation on medical assistance for women with normal high-risk pregnancies. MoH MoH
Develop and implement a regulation on referral and treatment of high-risk pregnancies and women with pregnancy complications.
Improve maternal mortality information/registration card.

7. To improve the professional ability and skills of medical personnel and to develop a salary and remuneration scheme based on work performance Improve the coverage of professional degree exams by allowing doctors to take such exams at the work place. MoH, NUM, Medical College UNFPA, WHO, UNICEF, ADB, GTZ
Investigate the possibility for post-graduate training for service providers at the work place.
Examine how salary increases can be made for doctors and health providers in rural areas.
Revise the under- and post-graduate training curriculum for medical students on prevention and management of obstetric complications.

8. To develop and implement guidelines on early detection of pregnancy complications at all levels of the health-care delivery system and timely referral to the next level Develop the guidelines “Early diagnosis of pregnancy complications, referral and treatment without delay at the next level of care.” MoH, MCHRC, City and provincial health departments and hospitals MoH, City and provincial governors, Health Department, Provincial general hospitals

ADB, Asian Development Bank; GTZ, German Technical Assistance Organization; MCHRC, Maternal and Child Health Research Centre; MoH, Ministry of Health; NGO, nongovernmental organization; NHDC, National Health Development Centre; NUM, National University of Mongolia; PHI, Public Health Institute; UNFPA, United Nations Population Fund; UNICEF, United Nations Children’s Fund.

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