Summary of Findings: Improving Birth Outcomes Within Health Care Systems

  • Successful implementation of the interventions recommended in previous chapters requires an effective health care system. The essential elements in that system for improved birth outcomes include skilled birth attendants at labor and delivery; trained, supervised staff (including village health workers) for other services; and, in the event of complications, access to essential obstetric and neonatal care through an effective referral system.

  • An effective referral system includes good communication between the referral hospital or health center and the skilled attendant, transportation to the referral facility, and access to a loan if needed.

  • Community trials of appropriate models of reproductive and neonatal health care will be instrumental in building accessible, acceptable, cost-effective health services to improve birth outcomes.

  • Each country should develop a strategy, a framework of activities, and the commitment of its leaders to reducing maternal, fetal, and neonatal mortality.

  • Surveillance of birth outcomes—especially maternal, fetal, and neonatal mortality—is essential to recognizing the burden of disease associated with pregnancy and childbirth, and to providing the data needed for identifying, prioritizing, and evaluating interventions to provide those services.

  • Each country should strengthen its public health capacity for recognizing, implementing, monitoring, and tuning interventions that meet their population needs and have been proven effective in similar populations.

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