Lessons for program design from the PMM projects.

The Prevention of Maternal Mortality (PMM) Network designed and tested projects for reducing maternal deaths. The focus was on improving the availability, quality and utilization of emergency obstetric care (EmOC) for women with serious complications. Teams' projects included interventions in health facilities (to improve skills and services and reduce delays in treatment) and in communities (to address lack of transport, funds and information concerning obstetric complications). The teams' results, reported in this volume, offer several lessons for program planners. Despite difficult conditions in the project countries, the teams demonstrated that it is almost always possible to make improvements in the delivery of EmOC. Their work shows that EmOC can be improved not only by concentrating on hospitals and physicians, but also by focusing on peripheral facilities and other qualified staff. The teams' findings regarding utilization of EmOC suggest that more people utilize services when they know them to be functioning well. Community efforts, including education and mobilization, have a role to play in improving utilization once services are in place. Improving EmOC need not be costly, because in many areas the necessary facilities exist and staff are already in place.