ABOUT
AMDD
Each year, almost 600,000 women die from
complication in pregnancy and childbirth, even though the
means exist to save the vast majority of these lives. Millions
more women are disabled. The AMDD Program was established
in 1999 to work with developing countries and international
agencies to improve availability, quality and utilization
of emergency obstetric care.
Many of the tools and methodologies being
used in the AMDD Program build on the work of the Prevention
of Maternal Mortality Program (1987-97). Both PMM and AMDD
are based on the following concept: most of the obstetric
complications that lead to maternal death can neither be
predicted nor prevented, but the vast majority of women
can be saved through prompt treatment. The evidence for
this rationale is set out in the chartbook Safe Motherhood
Programs: Options and Issues.
Among the key tools used by the AMDD
Program are the process indicators to assess the availability,
utilization and quality of emergency obstetric care, which
were developed by Columbia University and the United Nation's
Children's Fund (UNICEF) and issued by UNICEF, the World
Health Organization (WHO), and the United Nations Population
Fund (UNFPA).
Using these and other tools, AMDD and
its project partners work with governments to:
-
Analyze the national as well as local
medical, social and policy obstacles to providing emergency
obstetric care.
-
Upgrade health facilities to address
the causes of death and disability, including missing
or poor equipment, lack of emergency drugs, insufficient
blood supplies, inadequate or non-existent life-saving
and other skills, and provider attitudes.
-
Engage communities in improving and
extending health care services.
Strategy
In order to achieve results more quickly
and broadly, we are working with organizations that already
have operations in developing countries. This approach is
more economical and efficient, and it will broaden the community
of agencies dealing with emergency obstetric care.
The AMDD Program brings together developing
country ministries of health, non-governmental organizations,
and United Nations Agencies. By the end of the first year
of operations, AMDD partners were implementing projects
in more than two dozen countries. By the end of the second
year, this number had doubled. With an eye to the sustainability
of interventions, we emphasize using resources that already
exist in the country.
Focus on Human Rights
Persistently high maternal mortality
is being recognized as a violation of women's right to life
and health. The Heilbrunn Department for Population and
Family Health, where the AMDD Program is based, has long
had an active and innovative human rights component, and
has published widely on health and human rights.
AMDD seeks to give concrete expression
to human rights principles by advocating that countries
use the UN process indicators when they report on progress
in implementing international conventions, and by incorporating
principles such as dignity, accountability and participation
into field activities.
AMDD
articles on human rights
First Annual AMDD
Report
Second Annual AMMD
Report
download
rtf file
download and view
pdf file (this requires Adobe Acrobat Reader)
Team
Bios
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PARTNERS
& PROJECTS
PROJECT PARTNERS
The Program has established partnerships
with agencies recognized for their dedication and field
experience. They coordinate and implement projects to address
maternal mortality in three continents with AMDD funding
support and technical collaboration:
The projects listed above vary greatly
in size and scope: some are at
the district level, others are national. All began with
needs assessments, which show in stark relief the lack of
life-saving services for women. The findings were then translated
into projects with governments and the medical community.
TECHNICAL PARTNERS
AMDD technical partners bring extensive experience to the
Program and include:
PROJECTS
The Program is privileged to have Drs.
Mahmoud Fathalla, Adetokunbo Lucas and Barbara Kwast as
Senior Advisors.
The projects listed below vary greatly
in size and scope: some are at the district level, others
are national. All begin with needs assessments, which show
in stark relief the lack of life-saving services for women.
The findings are then translated into detailed project plans
with governments and the medical community.
- UNICEF: projects in Bangladesh,
Bhutan, India, Nepal, Pakistan and Sri Lanka
- UNFPA:
projects in India, Morocco, Mozambique and Nicaragua
- CARE:
projects in Ethiopia, Rwanda, Tanzania, Peru and Tajikistan
- The Regional Prevention of Maternal
Mortality (RPMM) Network: teams and projects in
17 sub-Saharan African countries
- Save the Children:
projects in Mali and Vietnam
- Reproductive
Health for Refugees: projects in 12 countries
- Leadership Fund: 2 projects
in India, 1 in Cameroon
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AMDD
NOTEBOOK
AMDD NOTEBOOK
Issue 4: June 2002
• English version
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and view pdf file (this requires Adobe Acrobat Reader)
• French version
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and view pdf file
• Spanish version
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and view pdf file
AMDD NOTEBOOK
Issue 3: February 2002
• English version
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and view pdf file (this requires Adobe Acrobat Reader)
• French version
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and view pdf file
• Spanish version
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and view pdf file
AMDD NOTEBOOK
Issue 2: November 2001
• English version
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and view pdf file (this requires Adobe Acrobat Reader)
• French version
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and view pdf file
• Spanish version
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and view pdf file
AMDD NOTEBOOK
Issue 1: June 2001
• English version
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and view pdf file (this requires Adobe Acrobat Reader)
• French version
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and view pdf file
• Spanish version
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and view pdf file
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WORKSHOPS
2002 Project Workshop,
Bangkok, Thailand - February 19th - 21st
Workshop
Report (English version) PDF
Workshop Report (Spanish
version) PDF
Workshop
Report (French version) PDF
AMDD WORKSHOP IN MARRAKECH, MOROCCO
February 19-21, 2001
• Workshop Highlights
download
rtf file
download and view pdf
file (this requires Adobe Acrobat Reader)
• Upgrading Services
download
rtf file
download and view pdf file
• Management
download
.rtf file
download .pdf file
• Human Rights
download
.rtf file
download and view .pdf file
• Monitoring
download
.rtf file
download and view .pdf
file
• Evaluation
download
.rtf file
download and view .pdf
file
• Documentation
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.rtf file
download and view .pdf
file
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RESOURCES
AMDD PUBLICATIONS
FACULTY PUBLICATIONS
Maine, Deborah, Safe
Motherhood Programs: Options and Issues, Columbia
University School of Public Health, 1993.
Maine, D., Wardlaw, T.M., Ward, V.M.,
McCarthy, J., Birnbaum, A., Akalin, M.Z. and Brown, J.E.
Guidelines for Monitoring the
Availability and Use of Obstetric Services UNICEF/WHO/UNFPA,
New York, September 1997.
Maine, Deborah; Akalin, Murat Z.; Ward,
Victoria M.; Kamara, Angela, The
Design and Evaluation of Maternal Mortality Programs,
Center for Population and Family Health, School of Public
Health, Columbia University, June 1997.
Hijab, N.,
They Need Not Die: the development
approach to preventing maternal mortality in Africa,
United Nations Development Programme, April 2000.
IJGO
and AMDD
As a result of an ongoing collaboration
between FIGO and the Mailman School of Public Health at
Columbia University, a special section on "The Keystone
for Averting Maternal Death and Disability" sponsored
by the University is featured in the International Journal
of Gynecology & Obstetrics. Please follow the link above
for key articles on EmOC published through IJGO.
AMDD TOOLS
AMDD Program Orientation
- A Tool for Learning
download
PowerPoint (English version)
download
PowerPoint (French version)
download
PowerPoint (Spanish version)
UNICEF/WHO/UNFPA
Guidelines for Process Indicators
• English version
download
and view pdf file (this requires Adobe Acrobat Reader)
• Spanish version
download
and view pdf file
UNFPA Distance
Learning Course on Reducing Maternal Deaths
Order
from the UNFPA site
PMM Design and
Evaluation Manual
• English version
download
and view pdf file (this requires Adobe Acrobat Reader)
• Spanish version
download
and view pdf file
AMDD TOOLS
Engender
Health/AMDD Prevention Manual
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WHAT'S
NEW
AMDD utilizes a variety of different
approaches to foster and support improvements in providing
access to EmOC. These approaches include women's group projects,
fistula repair projects, leadership grants, and awards.
Follow the links below to learn more about these activities.
WOMEN'S GROUP PROJECTS
SENDAS - Cuenca,
Ecuador
SENDAS is focused on developing local
capacity in the management of EmOC, promoting the rights
of women to receive quality obstetric care and ensuring
that the norms and national laws pertaining to health care
are being upheld. With this planning grant, SENDAS will
explore the implementation of a program - "Healthy
Maternity". This program will be an application of
the Free Maternity Law, which establishes free treatment,
as determined by the law, to women and children under the
age of five.
Likhaan - Quezon
City, Philippines
With AMDD funding, Likhaan will investigate
and identify the barriers to EmOC in the Philippines. The
impact of major national health policies (developed in the
early to mid-1990s) on the access and use of EmOC will be
examined. The primary interest will be in regard to the
legalization of the fee-for-service and income-retention
for public health care facilities and service providers.
FISTULA REPAIR
PROJECTS
Addis Ababa Fistula
Hospital - Addis Ababa. Ethiopia
In Ethiopia, 3 out of every 1,000 pregnant
women are estimated to develop Vesico Vaginal Fistula (VVF),
a debilitating, humiliating and life-threatening result
of obstructed labor. Addis Ababa Fistula Hospital (AAFH)
operates on about 1,200 women suffering from VVF yearly.
Through this AMDD collaboration, AAFH will be able to establish
fistula centers at 4 hospitals. A mobile team will go to
each of the 4 hospitals at least once a year for a period
of 10 days. The team will perform the needed reconstructive
surgery at the hospital and train the local doctor. In this
way, women who are suffering from VVF and are unable to
travel to AAFH will receive medical treatment at a fistula
center.
African Medical
and Research Foundation (AMREF) Obstetric Fistula Project
AMREF has been involved in surgical specialist
outreach services in support of disadvantaged rural communities
for the last four decades. Approximately 80% of the population
in the East African region live in rural areas. Maternal
mortality and morbidity has remained very high in this region
mainly due to poor access to quality reproductive health
services, poverty, malnutrition, poor road and communication
infrastructures, and grossly inadequate health services.
AMREF's outreach program identifies the gaps in the health
care system and develops methods of intervention. Through
its AMDD collaboration, AMREF will work to enhance the capacities
of indigenous health workers to prevent, repair, and support
women with obstetric fistulae at 11 hospitals, covering
remote areas of Kenya, Uganda, and Sudan.
PAC SERVICE DELIVERY
IPAS, Inc.
Funds from AMDD will improve the quality
of care in 5 health facilities and increase PAC service
delivery points in Ayacucho, Peru. A diagnosis of all PAC
service delivery points will be conducted to determine the
necessities, opportunities and possibilities of interventions.
Two diagnostic PAC courses and an intervention plan will
be developed. Ipas will sponsor training and monitoring
workshops. This work is in conjunction with our CARE project
and the findings will be presented to the MOH and agencies
working in reproductive health.
MIDWIFERY TOOLS
FOR EmOC SERVICE DELIVERY
Hesperian Foundation
Through a collaboration with AMDD, the
publication by the Hesperian Foundation entitled A Book
for Midwives (1995) will be revised to include all basic
EmOC functions. New chapters will be developed on how to
do pelvic exams, perform manual vacuum aspiration, etc.
Specifically, the book will be organized to help midwives
make timely decisions regarding complications during pregnancy.
LEADERSHIP GRANTS
Though its Leadership Grants, AMDD is
also able to provide one-time grants to groups working in
adverse conditions to care for women with obstetric complications.
Shimantik Urban
Primary Health Care Projects - Dhaka, Bangladesh
Shimantik Urban Primary Health Care Projects
(SUPHCP) offers services to the poor and lower middle class
in Dhaka. It has four clinics, each with a full time doctor
and paramedics providing 24-hour service. With the AMDD
Leadership grant, SUPHCP will be upgraded to provide comprehensive
EmOC. Funds will be used for renovations (OT, recovery room,
counseling room) purchase of instruments/equipment (laparotomy
set, suction machine, autoclave, etc.) and training (obstetrics/gynecology,
anesthesia, nursing).
Kunri Christian
Hospital - Sindh, Pakistan
Kunri Christian Hospital (KCH) serves
more than a hundred small villages. It receives all complicated
cases from the Rural Health Centers as well as small clinics.
KCH, through an AMDD Leadership grant, will be upgraded
to provide comprehensive EmOC. Funds will be used to purchase
instruments/equipment (instruments for C-section, ultrasound,
autoclave, etc.). In addition, workshops on EmOC are planned
for doctors/midwives and there will be some training for
TBA's.
Other Leadership
Grants:
Emmanuel Hospital Association - New Delhi,
India
Metet Hospital - Mbalmayo, Cameroun
Asha Kiran Hospital - Andhra Pradesh, India
Solu Hospital - Solukhumbu, Nepal
Comprehensive Rural Health Project - Jamkhed, India
AWARDS
FIGO
Distinguished Community Service Award
International
Confederation of Midwives (ICM) Award
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