| Strategy 1. Decrease distance to skilled birth attendance by increasing the number of EmONC facilities |
Establish additional EmONC facilities and strengthen existing facilities to provide the following services 24 hours per day, 7 days a week, for all pregnant women in the district:
Clean and safe basic delivery services Quality HIV testing Counseling and treatment (for woman, partner, and baby as appropriate) Essential newborn care 24-hour availability of staff capable of managing delivery complications When needed, timely facilitated referral to higher-level facility
| Upgraded infrastructure to a sufficient number of public and private facilities in appropriate geographic locations and provided necessary equipment and commodities for EmONC service delivery Hired midwives, medical officers, and anesthetists Trained medical officers, anesthetists, midwives, and nurses in EmONC Provided on-site mentorship of health facility teams using protocols
| Upgraded infrastructure and provided necessary equipment to provide services for pregnant women in public and private facilities in appropriate geographic locations Hired a sufficient number of skilled birth attendants and midwives Trained doctors, midwives, and anesthetists in EmONC and the Electronic Logistic Management Information System Provided on-site mentorship of health facility staff using protocols, forms, and drills
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| Strategy 2. Improve accessibility of EmONC facilities |
Create a communication and transportation referral system that operates 24 hours per day, 7 day per week, and:
Is consultative, protocol-driven, quality-assured, and integrated (public and private) Ensures that women with complications reach emergency services within 2 hours Includes buying ambulances, motorcycles, motorbikes, and communication equipment like 2-way radios Provides or renovates, where appropriate, temporary lodging in maternity waiting homes for women with high-risk pregnancies or who live more than 2 hours travel time to an EmONC facility Provides service delivery vouchers and vouchers for transport to basic delivery care facilities and referral to higher-level facilities Forms district-level transport committees to improve referral
| Created district transportation committees to improve coordination of ambulances for referrals Provided service and transportation vouchers to women for transportation to facilities nearest to them and access to antenatal care, delivery, and postnatal care services at the facilities Trained village health teams to encourage birth preparedness and escort women to the facility Procured ambulances to facilitate transportation for referral Renovated maternity waiting homes
| Repaired and procured 2-way radios where needed Procured ambulances and motorcycle ambulances; strengthened district transportation committees; and ensured strategic placement of ambulances Renovated and constructed maternity waiting homes Strengthened district transportation committees to improve coordination of ambulance services Trained Safe Motherhood Action Groups to encourage birth preparedness and escort women to the facility Established village-level savings programs for pregnant women to encourage better planning for delivery
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