Introduction

Contraceptive Requirements and Logistics Management Needs

Training

Coordination and Collaboration

Monitoring and Evaluation

JOICFP-Executed Projects

Centres of Excellence for South to South Cooperation

Safe Motherhood Projects

HIV/AIDS Prevention Interventions

Implementing the Reproductive Health Approach

UNDAF Assessment

A thematic evaluation of UNFPA-supported safe motherhood strategies was completed in 1998. This evaluation was based on a sample of UNFPA-supported projects in seven countries — Bangladesh, Guatemala, Morocco, the Niger, the Philippines, Senegal and the United Republic of Tanzania. These nations represent a wide range of country situations and experiences in implementing projects designed to reduce maternal mortality and morbidity. Diagnostic factors for each case study were identified, and data were collected in-country by an evaluation team composed of a national and an international consultant.

The evaluation found that all projects reviewed responded to national concerns about high levels of maternal mortality. At the same time, even though all projects responded to a national priority and were relevant in a broad context, they were based on national-level data rather than on assessments of needs at the local level. As a result, the projects did not address clearly defined local problems. Thus, even though most of the projects focused on specific regions or districts, the strategies did not address the particular causes of maternal deaths in those selected areas. The evaluation therefore recommended that formal needs assessments, based on the causes of maternal deaths at the local level, be an integral component of the project formulation.

The strategies chosen to reduce maternal mortality, the evaluation found, were not necessarily the most effective ones. For example, all of the projects promoted antenatal care as part of their safe motherhood strategies, even though evidence shows that antenatal care to detect pregnancy-related complications, in and of itself, cannot bring about significant reductions in maternal mortality, since every pregnancy involves risk. Also, four of the seven projects had training programmes for traditional birth attendants. It is now recognized that TBAs alone cannot substantially reduce maternal mortality. If TBAs are to be involved in the provision of maternity care, linkages between them and the formal health system must be established or strengthened.

Monitoring at the central level occurred regularly for almost all the projects reviewed. Monitoring at lower levels, however, was often neglected. This hampered the ability of the project management team to conduct in-depth technical analyses. Overall, the evaluation found that project personnel focused most of their time and effort on ensuring that the activities were carried out rather than on assessing whether the activities implemented were actually improving maternal health care.

Since most projects did not identify indicators to determine the effectiveness of the selected strategy, there was insufficient information to show whether activities had achieved the intended results. The evaluation did show that in most cases there had been an increase in the provision of different maternal health services. However, it was not possible, with the exception of the Bangladesh project, to determine whether the increase was a result of the UNFPA-supported activities. The evaluation recommended that project managers identify indicators that can provide information on the progress made in implementing the selected strategy and regularly collect data at the levels where activities are conducted. Such information should be used at local and central levels to resolve problems, assess progress in preventing maternal deaths and determine policies related to maternity care. In addition, the evaluation underscored the importance of process indicators. The indicators selected should be practical, operationally significant, and based on available and reliable data.

A United Nations Development Assistance Framework (UNDAF) assessment
noted the importance of the Fund's support to programmes targeting
the kind of poverty that forced these youngsters into the labor force.

The evaluation found that although the Safe Motherhood Initiative is conceptually a concerted effort involving a variety of agencies, the projects studied either were conducted in isolation or were not coordinated with other projects. Moreover, none of the projects provided for a review of the status of maternal mortality in partnership with other agencies. The evaluation underscored the crucial importance of partnerships among agencies, donors and national governments to the success of safe motherhood programmes, since no one organization can by itself bring about a decrease in maternal mortality.

The outcome of the thematic evaluation was reviewed by the UNFPA Policy and Planning Committee, which endorsed its recommendations. It was decided that advisory notes on how to integrate safe motherhood interventions into reproductive health programmes would be prepared on the basis of the lessons learned from the evaluation.