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close this bookMother-Baby Package: Implementing Safe Motherhood in Countries (WHO, 1996, 108 p.)
close this folderHOW to operationalize the Mother-Baby Package
View the document(introduction...)
View the documentDefine national policy and guidelines
View the documentAssess needs
View the documentPrepare national plan of action
View the documentEstimate costs
View the documentIdentify sources of financial support
View the documentDevelop detailed implementation plan
Open this folder and view contentsImplement planned activities
View the documentMonitor and evaluate




· Most maternal deaths have the same causes
· Most pregnancy complications can be prevented or treated
· Safe motherhood benefits babies too
· Safe motherhood is attainable


· Goals and objectives
· Family planning
· Basic maternity care
· Prevention, early detection and management of complications


· Define national policy and guidelines
· Assess needs
· Prepare national plan of action
· Estimate costs
· Identify sources of financial support
· Develop detailed implementation plan
· Implement planned activities
· Monitor and

The challenge which now confronts decision-makers, health care planners and managers, and health care providers is to ensure that every pregnant woman has access to high-quality essential care. In seeking how best to achieve this, interventions will have to be based on existing primary health care systems. In order to ensure that as many pregnant women as possible have access to the essentials of care, a balance will have to be achieved between what is absolutely critical for all women and what would be ideal if circumstances permitted.

The Mother-Baby Package is an integral part of the wider Safe Motherhood Initiative which has, since its inception in 1987, achieved notable success in alerting the world to the dimensions and nature of maternal mortality. There is increasing recognition of the importance of safe motherhood for improving the health of newborns and thus reducing continuing high levels of infant mortality and morbidity. Assuring improved maternal and newborn health is seen as a fundamental prerequisite for family health and for social and economic development. The returns on investment in the health of women and children are generally acknowledged. Moreover, investing in maternal health care is one of the most cost-effective health interventions in terms of benefit to the whole community.

The Mother-Baby Package is not a new vertical programme. Rather, it represents a way of revitalizing maternal and newborn care services and ensuring that basic core set of interventions - but only those interventions that have been proved to be effective and feasible - is accessible to all pregnant women and to their newborns.

The Mother-Baby Package has been defined for global action. Country-specific goals, strategies and activities have to be defined in order to initiate nationwide programmes over a specified time-scale. It is not possible at a global level to recommend country-specific guidelines for operationalizing the Package. Each country will have to adapt the contents of the Package in the light of its own specific conditions and to implement it in accordance with its own structures.

The goals, objectives and targets of the Package defined earlier in this document should be defined and achieved by all countries at progressively more peripheral levels (national, subnational and district). The goals and targets should include all the critical elements of the Package.

Several countries have already started the process of planning and implementing national safe motherhood programmes. Based on their experiences, and on the expertise of the various partners in the Safe Motherhood Initiative who have been working with countries, the essential steps required for developing and implementing national action plans are summarised below. This section is designed as a general guide only. More comprehensive and detailed guidelines on planning, managerial and logistic components of Mother-Baby Package implementation will be made available by WHO.

In order to implement the interventions described in the Package, countries need to undertake a series of activities, many of which will be the prime responsibility of the health care system. Others, however, will have to be developed in collaboration with other sectors, notably in the areas of finance and planning, education, transport and communication.

The process outlined below focuses largely on the activities that are the responsibility of the health sector. The steps described do not necessarily follow in a sequential manner. Several can be undertaken concurrently. Broadly speaking, the activities comprise definition of national policy and guidelines; situation analysis and assessment of needs; preparation of national action plans; estimation of costs of implementation; identification of sources of support at national and international levels; preparation of detailed implementation plans; implementation of interventions; and monitoring and evaluation.