The International Federation of Gynecology (FIGO) has launched an initiative called Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC). The Bill and Melinda Gates Foundation funded the project. This initiative started in 2008 and ended in 2013.
The aim of this initiative is to improve maternal and newborn health in low and middle income settings. Indeed, the ratios of maternal and neonatal death are still very high despite the current efforts that have been made since the Millennium Declaration 2000.
In total, eight associations of gynecology and obstetrics were selected to be part of this initiative: Burkina Faso, Cameroon, Ethiopia, India, Mozambique, Nepal, Nigeria, and Uganda.
This initiative has three main objectives:
Strengthen capacities of members of these associations
Influencing national health policies
Improving clinical practices
The theory underlying the activities of this initiative is to enhance leadership of national obstetricians & gynecologists associations in order to give them the skills to advocate maternal and newborn health at the government level, to develop clinical guidelines and the implementation of maternal death and near miss reviews. FIGO’s initiative aims to improve clinical practice in using two main tools: Evidenced-based guidelines and maternal death and near miss reviews.
The supplement presents the experiences resulting from this initiative in the different countries. It shows how the maternal death reviews are powerful tools to understand the determinants of maternal deaths and also how this clinical tool can be used as a tool for advocacy on maternal and newborn health. Maternal death review is presented as a tool at the cross roads between the clinic and the politic.
Perron’s paper is a description of an intervention that aims to strengthen the capacity and skills of their associations and its members. The questionnaire that was administered was composed of different dimensions such as the culture (mission, vision, values), the operational capacity (development of administrative guidelines), performance (training and technical support) and external relations (how the association was perceived by the other stakeholders).
Osman’s article describes the design used by the Association of Gynaecologists of Mozambique to strengthen their organizational capacity and leadership. A strategic plan was set up to address the strengths and weaknesses of the association. The strengths that are identified are: the attractiveness of the association for experts in maternal and reproductive health, the recognition of the association as a partner for the Ministry of Health. The weaknesses targeted are the insufficient funds to finance all their activities, the low capacity to generate income and the poor communication between members.
Leke’s paper presents the development of collaboration between the association of Gynaecologists of Cameroon and the Ministry of Health. A memorandum was signed on reproductive health. This collaboration would have to facilitate transfers of skills in terms of monitoring and evaluation. The association is recognized as a partner of the Ministry of Health.
Chaudahry’s paper focuses on the description of different interventions to improve communication between members and other stakeholders.
The papers of Lewis and De Brouwere et al. present the tools and guidelines for conducting efficient maternal death and near-miss reviews, the training for health professionals to conduct maternal death reviews. These papers are more technical and describe the different steps for conducting efficient maternal deaths reviews.
Ouedraogo’s paper describes the intervention that aims to improve the quality of health care, especially to strengthen the humanization of maternal health care. According to the results, poor conditions of work (lack of infrastructure) explain the low quality of care. The intervention is based on a participatory approach.
Gebrehiwot’s paper shows the relevance of using maternal death reviews to understand the determinants of maternal mortality. According to the results of the study, socioeconomic factors, the level of education (60.3%) and the lack of employment (75.6%), largely explained maternal mortality. The majority of births is at home. It explains why 70% of women arrive at the hospital for serious obstetric complications. Only 44 % attended antenatal care consultations among women who died and the near miss. The study was conducted in 10 hospitals in 4 regions.
Purandare’s article shows the relevance of a computerized system of maternal deaths. A software has been designed to better account for maternal deaths and offers several options on presenting data related to maternal death. For example, the software can calculate the proportion of maternal deaths according to the causes, the arrival at hospital.
Shaw’s paper is more a conceptual article. It presents a discussion on different concepts. The concepts of advocacy and influence are defined. The paper contains also a framework to strengthen associations to act as a leader to improve maternal and newborn health.
Achem’s article describes the experience of an advocacy strategy for the development and implementation of maternal death reviews in Nigeria. The Nigerian experience shows how can an association plays an important role to advocate for the improvement of maternal and newborn health. This experience identifies the active ingredients to have to a better advocacy in maternal health: technical innovation, political will, and important financial resources
Beyeza Kashesya’s paper shows how the results of maternal death reviews has been used as a tool to develop advocacy to sensitize the media and Parliament to maternal health in Uganda.