Monitoring obstetric services: putting the UN guidelines into practice in Malawi. 1: developing the system

The UNICEF/WHO/ UNFPA 'Guidelines for Monitoring the Availability and Use o f Obstetric Services' was published in 1997 as a guide for implementing pro cess indicators. The Malawi Safe Motherhood Project covers 5 million people and was the first large project to introduce the new indicators as part of a routine monitoring system. A rigorous process of needs assessment, tools development, operations research, field testing and training was conducted . It was necessary to reach agreement on locally appropriate standard defin itions of obstetric emergencies, reporting formats and catchment population s. Underreporting of emergencies, misreporting of maternal deaths and doubl e counting of referrals were minimized by improving recording tools. Time, cost, political and technical inputs are important considerations - in Mala wi, the system took 1 year to set up at a cost of $100000. Developing a rou tine monitoring system to obtain data for the process indicators is feasibl e, but requires adaptation of the cross-sectional evaluation methods descri bed in the UN Guidelines. (C) 2001 International Federation of Gynecology a nd Obstetrics. All rights reserved.