Clarifying our signals
Revising the emergency obstetric care (EmOC) framework and manual for quality of care and accountability
Members of the Maternal and Newborn Health Group are working on a 3-year (2019-2022) sub-award from Columbia University’s Averting Maternal Death and Disability (AMDD) project as part of a grant from the Bill and Melinda Gates Foundation to support a review of the emergency obstetric care (EmOC) monitoring framework.
The EmOC indicators and guidelines were originally published in 1997 based on a series of assumptions about maternal mortality and the functions of low- and middle-income health systems, and the monitoring framework was later revised in 2009 by WHO, UNFPA and AMDD. The original indicators are built around the concept of signal functions, the primary clinical interventions used to treat direct obstetric complications which, at the time, accounted for over 75% of all maternal deaths. The signal functions are divided into two levels of care: basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC).
Whilst the EmOC framework has been influential in national monitoring and research, much has changed in the last 30 years. Signal functions have been added for neonatal resuscitation, and LSHTM has proposed for routine maternal and neonatal care, for small and sick newborns, and for reproductive and sexual health services. Now, this new project proposes a fundamental review, rethink and revision of the framework, with the aim of improving met need for emergency obstetric and newborn care and enabling countries to meet their current goals for improving the experience of MNH care and reducing maternal mortality, neonatal mortality and stillbirths.
In addition to LSHTM, the Clarifying Our Signals project steering committee comprises individuals from multiple agencies including WHO, UNFPA, UNICEF, USAID, and other academic institutions. The overall project will incorporate a human-centered design to ground four different workstreams: signal functions, levels of care, quality of care and implementation experience. LSHTM will co-lead the workstream on signal functions and look at how EmOC monitoring should link to the rest of the continuum of care, including care for small and sick newborns. At the end of the project, a revised EmOC framework will be developed alongside an updated manual with guidance for their measurement and use in countries.