The programme had no measureable impact on maternal mortality. One reason may be that Malawi health policy changed during the trial to require women to deliver in a health facility, not at home with a traditional birth attendant.
When the trial started, around 55 percent of women delivered their babies in the community. Since then the number of women delivering in a facility that provides obstetric care has increased dramatically, placing a major additional burden on already-stretched clinic staff.
"Our best guess is that these facilities reached a tipping point and became overwhelmed," says Dr. Barker. "Now only 25 percent of mothers deliver in the community."
Working on both supply and demand
The project tackled both the demand for services and the supply of quality care. On the demand side, women were encouraged to make decisions that would help ensure regular check ups during pregnancy and speedy access to the clinics and hospitals around the time of birth, while on the supply side the project worked to provide women and newborns with quality care once they got to a health facility.
MaiKhanda's unique combined approach was able to tackle all of the "three delays" that result in high rates of maternal and newborn deaths in many poor nations: delay in seeking care; delay in reaching a medical facility; and delay in receiving excellent care once at the health facility.
Nine hospitals and 29 health centers that provide basic emergency obstetric care were included in the quality improvement programmes of MaiKhanda.
By teaching health staff and administrators how to improve the quality of data they were collecting and feeding back reports quickly to clinics, front line health staff could, for th
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Hoffman & Hoffman Worldwide