Finalists

Each year in sub-Saharan Africa 880,000 babies are stillborn and 1 million die in the first week of life. Many of these deaths are due to maternal infection with HIV, syphilis or malaria, or to maternal anaemia, which cause stillbirth, preterm birth and low birth weight, increasing the risk of neonatal death. In rural Tanzania, as in many other African countries, more than 80% of pregnant women attend antenatal clinic, but few are screened and treated for these conditions – an important missed opportunity to save newborn lives.

Timely access to safe blood transfusion is an essential component of antepartum, postpartum, and post-abortion care to prevent deaths from haemorrhage and severe anaemia. Peri-partum haemorrhage alone accounts for 34% of obstetric deaths in Africa and is an important cause of stillbirths and neonatal deaths. Access to safe blood for transfusion is an integral component of comprehensive emergency obstetric care. A major roadblock to the provision of blood transfusions in low/middle-income countries is not enough safe blood in the right place at the right time.

Problem: Hypertensive diseases of pregnancy (HDP) and preterm birth (PB) are major causes of maternal and newborn death, particularly in rural settings where access to emergency obstetric and neonatal care is limited.

Well-funded, effective vaccine initiatives have developed important technologies that can positively impact other health care sectors. The challenge is to clearly identify and proactively exploit the most promising "spin-off" opportunities early on. By redirecting recent innovations in vaccine cold chain toward safe blood storage, we anticipate an immediate, life-saving impact for women experiencing obstetric emergencies. They might otherwise die from lack of available blood or from bacterial and viral infections resulting from improper storage conditions or infected donor blood.

mMitra is a free mobile voice messaging and animated film service in rural India that will provide culturally appropriate comprehensive information on preventive care and simple interventions during the perinatal period. The voice messages will be in the local dialect and specific to the woman's gestational age or the age of the newborn and will be sent weekly free of cost directly to pregnant women and mothers with newborns.

Neonatal mortality in developing countries averages about 34 per 1000 live births and the most common cause of death is bacterial infection. Neonatal sepsis contribute to 34.6% of all early onset infections and causes about 1.6 millions deaths a year. Sepsis mortality is directly related to the severity of stage at which it is diagnosed. Therefore, it is widely accepted that the effective treatment of neonatal sepsis requires early detection and rapid therapeutic intervention.

Hypothermia is a serious risk for increased morbidity and mortality in newborn infants, especially low birth weight and preterm. In developed countries, expensive incubators and radiant warmers have effectively reduced hypothermia in newborns. However, in developing countries, inexpensive alternative approaches of skin-to-skin care is under-utilized. An innovative, low-cost solution to increase skin-to-skin care and prevent hypothermia is necessary for low- and middle-income countries.

Mobile maternal health voucher programs have the potential to transform a novel incentive scheme into a cost effective and efficient way to spark an increase in the utilization of health services and to reduce maternal morbidity and mortality. Health voucher programs enable women to purchase vouchers for maternal health services at a fraction of the cost and redeem them at quality-accredited facilities, public or private. This innovative strategy has been being successfully piloted in several low-income countries.

Rationale: Maternal and newborn mortality and morbidity are high in Afghanistan. Rates of antenatal care, skilled attendant at birth and postpartum care are low. The Afghan Mortality Survey 2010 found that the reasons for not using health services often related of not understanding the need for care. Therefore the links between communities and health providers and facilities need to be strengthened.

This integrated innovation engages elected rural ward councilors in rural Zambia to remove local barriers to use of key antenatal, intra-partum, and postnatal care services and practices in a poor, under-served constituency. Locally-elected representatives, though rarely convoked to improve maternal-newborn care (MNC) directly, constitute a promising, but untested, entry point to save lives by strengthening leadership skills and democratic processes.

The persistence of mortality and severe morbidity from pre-eclampsia and eclampsia (PE/E) demands a new approach. Jhpiego—in a growing collaboration with Johns Hopkins University Center for Biomedical Innovation and Design (JHU-CBID), Laerdal Global Health, and other manufacturers—is making available new technologies and offering selected interventions through a new community-centered platform to reduce PE/E, the second leading cause of maternal mortality (after hemorrhage) worldwide.

Neonatal sepsis is the single greatest cause of preventable death in children living in tropical countries. Most deaths occur in or near home. Prompt parenteral administration of effective antibiotics is life saving, but seldom possible in the rural tropics. We propose to develop a rectal formulation of a third generation cephalosporin antibiotic for reducing mortality through early community-based management of neonatal sepsis.

The 1000 Days Initiative is a transformational approach to producing healthy mothers and live, thriving babies amongst economically vulnerable populations.  It replaces the compartmentalized efforts of the past with an integrated approach of wellness and health services over the course of a woman's pregnancy and the first two years of life.  It combines best practices for maternal and newborn care with the provision of nutrition, immunizations, and clean water in a single package.

Low-resource environments present many challenges for maternal and neonatal healthcare delivery. Among these, is a lack of basic equipment to preserve and protect newborns, particularly at-risk neonates. For example, a simple incubator/warmer is lacking in most primary health care facilities. Devices to provide respiratory support are also lacking. Furthermore, available solutions pioneered by developed countries do not fare well in a resource limited area- for example, reliable electricity supply is not readily available.

Over half of childbirth deaths in developing nations are attributed to treatable conditions such as hemorrhage from an abnormal placental location, fetal malpresentation, or obstructed labor. If identified in advance, such conditions can be prevented through life-saving treatment. In sub-Saharan Africa, a woman has 1 in 30 lifetime chance of dying from complications of childbirth. While ultrasound is effective in diagnosing many of these problems, traditionally it requires expensive equipment; high electrical power; and on-site, highly trained operators.

Micro Health Franchise System empowers community midwife worker in providing high quality and cost effective healthcare services to mother and child in poor communities; at their door steps. Micro Health Franchise system also provides entrepreneurial support to the community midwife workers that lead to the standardization of services, access to financial services and having support by an efficient referral network that can respond to emergencies in a proactive manner. At the core of this solution lies the Telehealth module.

Catholic Relief Services, in collaboration with local implementation partners the Nicaragua Ministry of Health (MoH) and Caritas Matagalpa, and supported by researchers at John Hopkins Bloomberg School of Public Health and the Sustainable Sciences Institute, proposes to scale up a proven integrated solution that optimizes birth outcomes in the poorest and most remote communities of Matagalpa, Nicaragua where high maternal and neonatal mortality continues to be a critical problem.

Blood transfusions in the countries of sub-Saharan Africa and Southeast Asia are critically important. The low standard of living and malnutrition in these countries leads to high frequency of anemia, particularly in children and women. According to World Health Organization (WHO) 30 to 40% of women in sub-Saharan Africa have anemia and about 25% of postpartum deaths in women are related to obstetrical hemorrhages. While blood transfusions are essential, blood safety remains a major problem in the developing world.

While there is global agreement that investing in health systems is critical to reducing maternal and newborn mortality, complimentary community-based approaches have been given less attention. Recently it has been acknowledged that a mobilized community which acts to support families, communities and mothers knowledge around pregnancy and birth will contribute significantly to a reduction in maternal and newborn mortality.

Nearly half of all infant deaths occur in the first 28 days after birth, with prematurity and low birth weight as leading causes. We propose to assess the feasibility of development and distribution of an indigenous energy protein supplement to at-risk pregnant women attending health centers in rural Gujarat to reduce infant intrauterine growth retardation and monitor key biological parameters of their at-risk infants through a low cost mobile device.

Maternal and neonatal death rates are high in the Western Visayas region of the Philippines, where access to skilled birth attendants is relatively high but compliance with appropriate antenatal care (ANC) and postnatal care (PNC) practices is poor. World Health Organization (WHO) essential protocols for reducing maternal and infant mortality are not extended into the communities or into the homes, where many women give birth. Government services are are delivered through separate, vertical, poorly-coordinated programs. 

Adverse birth outcomes related to the length of gestation (preterm birth; PTB) and fetal growth (low birth weight or small for gestational age; SGA) are recognized as the two most significant disorders in maternal-child health at global scale. In the developed world, the preterm birth rate approximates 7%. In Malawi, this rate nearly triples to reliable estimates approximating 20.3%, and is felt to possibly occur as a result of maternal infection and inflammation.

Does hand washing with soap and water or alcohol-based hand sanitizers address the well-documented need for clean birth practices? Clean birth practices, including hand hygiene of birth attendants and use of clean or disinfected instruments to cut and tie an umbilical cord, are of critical importance. Evidence suggests that hand hygiene practices among birth attendants and disinfection of birthing equipment and surfaces are not always optimal. Often water and soap or alcohol-based hand rubs are not available.

Reducing late fetal (1.2 million), maternal (150,000), and early neonatal (1.4 million) deaths remains the most critical global health challenge. Additionally 1.4 million women suffer severe acute morbidities (“near miss”).  Development and scaling of innovative approaches to provision of simple cost-effective interventions to improve intrapartum outcomes is needed.

In this decade, reproductive health voucher programs have successfully reduced maternal and infant mortality and morbidity through the innovative financing of reproductive health services.

Cephalopelvic disproportion (CPD) is the primary mechanism of obstructed labor, one of the five major causes of maternal mortality globally. A term literally translating to the mismatch between the fetal skull and woman's pelvis, this condition is most felt by women who, because of poor nutrition, young age of motherhood, and/or bone-affecting disease, have an improperly developed pelvis that is unsuitable for childbirth.

Under-nutrition is the underlying cause of 3.5 million preventable maternal and child deaths each year. JSI is developing innovative technology to support the delivery of nutrition actions at critical times in the life-cycle of women, infants and young children, especially during the 1,000 days between a woman's pregnancy and her child's second birthday.

No single intervention can effectively address the maternal and neonatal health crisis in Lesotho, given the complexity of structural barriers to care; the low demand for services for maternal and neonatal health (MNH) and their low quality; and the unrelenting HIV epidemic. Thus, we propose an innovative combination approach that bundles evidence-based MNH and HIV interventions with incentives for participating individuals and health facilities based on all-or-none accomplishment.

This proposal outlines a model for demonstrating whether a Conditional Cash Transfer Scheme (CCTS), integrated into a larger program effort, can increase demand for and utilization of maternal and neonatal health (MNH) services in rural Zambia, where health indicators remain stubbornly dire. The model is based on evidence suggesting that current demand-side interventions, including increasing knowledge of danger signs and raising awareness of available services will not be sufficient to overcome the barriers necessary to bring utilization in line with clinical need.

Severe bilirubin encephalopathy from inadequately treated jaundice is a global health threat to newborns. Developing areas in Africa, the Middle East, and Southern Asia that have a high prevalence of the heritable hemolytic condition, G6PD deficiency, are particularly vulnerable, and numerous countries in those regions report jaundice as the second or third leading cause of neonatal death.

Each year millions of births, including those in facilities, occur without effective monitoring or appropriate response. The baby’s heart rate is the most important signal of distress in labor. Inadequate heart rate monitoring and failure to respond to distress is an important determinant of almost 1 million newborn deaths and 1.2 million stillbirths each year globally. Effective monitoring during labor in challenging settings depends on rugged, reliable, simple devices able to be used without electricity or batteries.

OXYVITA Inc. has developed a powder form of its transfusible hemoglobin based oxygen carrier. This product has undergone initial testing in an animal hemorrhage model with success, making the product the first powder form of a red blood cell transfusion alternative in the world. In third world settings where the greatest percentage of maternal hemorrhage death occurs, ease of administration of the product is vital. Currently, our product is designed for use in a hospital setting, however, its real benefit is that it can be used in remote locations, injected on site by a medic or midwife.

China is a lower-middle income country, with a population of 1.34 billion. Among this enormous population, there is dramatic disparity of maternal and neonatal health, with the rate of preterm low birth weight (PLBW) ranging from 5~6% in the developed metropolises to >20% in the poor rural areas. One possible reason for the high PLBW rate is poor maternal oral health, which adversely impacts the birth outcome.

Jhpiego and its partners (Johns Hopkins University Center for Bioengineering Innovation and Design and Laerdal Global Health) propose to rapidly develop and conduct initial field-testing for an “E-Partogram,” an affordable, easy-to-use, handheld electronic decision-making tool for preventing or managing complications during labor. The E-partogram could positively transform safe childbirth by enabling front-line providers to more rapidly assess and respond to labor complications and receive crucial guidance to save the lives of women and newborns.

Acute respiratory infections are the leading cause of global child mortality. In the developing world, oxygen therapy is often the only treatment option for babies who are suffering from respiratory distress. Without the added pressure of a bubble Continuous Positive Airway Pressure (bCPAP), babies still struggle to breathe and can suffer serious complications, and frequently death. A stand-alone bCPAP device can cost $6,000, too expensive for most developing world hospitals.

Jhpiego proposes a capacity building and sustaining "Day of Birth" approach to bring lifesaving services to remote health facilities where complications must be prevented and managed simultaneously and swiftly, often by a single provider. This approach uses evidence-based practices in prevention and treatment of the two biggest killers of women and newborns in the hours after birth -PPH and neonatal asphyxia.

NOvate Medical Technologies, LLC ("NOvate") is a New Orleans-based medical device development company focused on commercializing high-quality, low-cost medical products. NOvate is committed to delivering medical solutions, novel training programs, and information technologies which address the health needs of the developing world. NOvate's first product offering, SafeSnip, is a patent-pending disposable and degradable plastic obstetric device that simultaneously cuts, clamps, and shields the umbilical cord from infection.

The world is facing a shortage of 4.3 million health workers, with every region except Europe showing a shortfall. Rapid urbanization in developing countries is exacerbating shortage of health workers in rural areas, as trained professionals seek work in more affluent urban conurbations.

Baby Monitor, a mobile interactive voice response system, will bring clinical assessment and referrals directly to mothers and their infants in resource-poor settings who are unlikely to access routine care. To date, mobile applications largely have been used to send patient reminders and health information or to collect patient information through intermediaries such as community health workers. Patients in developing countries have not been end-users of mobile diagnostic tools and medical record systems.

Rationale: Facility-based births must be superior to home deliveries for both the mother and the infant. This is not always the case in remote poorly equipped first level maternities in SubSaharan Africa with poorly trained staff. 

In poor communities, Participatory Women's Groups (PWGs) that focus on maternal and newborn health can dramatically reduce newborn deaths and catalyze improvements in the demand, delivery and quality of maternity services. Trials in Nepal, India, Malawi and Bangladesh showed that engaging PWGs in participatory learning and action reduced newborn deaths by up to one third. Coverage is important. In Bangladesh, with one group per 1500 population, newborn mortality fell by 7%; when scaled to 1 group in 300, mortality fell by 34%.

Each day, 3,100 newborns die worldwide within 24 hours of birth. Ninety percent of these babies could be saved if breastfeeding and warmth are provided immediately. Very small babies (newborns weighing less than 1,800 grams) often are also very sick and should be cared for with a thermoregulation device initially, and managed with skin-to-skin care once they become stable. If such babies are not treated, they can suffer complications of hypothermia, including respiratory distress, acidosis, hypoglycemia, and even death.

Rationale: More than one-quarter of neonatal deaths are due to neonatal sepsis (NS). NS is usually treated with parenteral and oral antibiotics but case fatality rates are high. It was shown that Zinc ions are crucial for multiple aspects of the immune system, including the normal development, differentiation, and function of cells belonging to both innate and acquired immunity. Modulation of immune response by oral Zinc supplementation is considered as a single approach for multiple diseases.

Low birth weight (LBW) infants are at higher risk of hypothermia due to their increased surface-to-mass ratios; studies indicate that the prevention and management of hypothermia through thermoregulation can reduce neonatal mortalities by up to 42%. Roughly 500 district hospitals in Vietnam lack neonatal intensive care units, forcing them to transfer infants with pathologies to provincial hospitals. Transport is unsophisticated and lacks standardization; ambulances, when available, are not equipped to provide thermoregulation. Transport is the weak link in the warm chain.

Early detection and treatment of sexually transmitted infections (such as congenital syphilis) in pregnant mothers is an extremely cost-effective measure to avoid adverse health consequences to both mothers and their children. However, despite their clinical importance, STI diagnostic tests are normally unavailable in rural regions. Here, we propose to scale up development and deploy in Rwandan community-level clinics a novel, low-cost, front-line diagnostic testing device that enables simultaneous detection of HIV and syphilis.

We seek to address a critical fourth delay that sustains high rates of maternal and neonatal mortality in western Kenya: the delay in a community’s accountability to its mothers and infants. We will develop an innovative information technology that fosters rapid communication and feedback between mothers, their communities, and their healthcare providers: the Mother-Baby Health Network.

Interventions to improve maternal and newborn outcomes in resource limited regions such as Kenya are successful when they aim at improving knowledge on danger signs of pregnancy, advice on when to seek assistance, and increase health facility deliveries. We propose a public-private partnership program to promote quality, timely utilization, and monitoring of focused ante-natal care and skilled delivery services. This will be through a network between health facilities and solar-powered community health kiosks (M-Afya kiosks) connected through mobile phone telephony .

It is very well possible to reduce maternal and neonatal death by ICT, mobile phones, performance based financing and task shifting. Although there is progress in these areas in Uganda, there are still factors contributing to the death of pregnant or birth-giving women and newborn children like hemorrhage, sepsis/infection, hypertension, preterm birth and tetanus. Interventions to avoid or prevent problems such as lack of correct information, a skilled attendant and access to quality health care still show gaps.

The project aims to address the consequences of male fertility preferences when men are uninformed about of the health risks associated with pregnancy and childbirth, namely low uptake of available family planning and low understanding of the benefits of birth spacing. In order to inform men of these risks, an innovative curriculum has been designed over one year of piloting that introduces family planning as a way to mitigate potential maternal and child mortality.

Obstetric hemorrhage is estimated to cause 25% of maternal deaths and is the leading direct cause of maternal mortality worldwide. Postpartum hemorrhage (PPH), characterized as severe bleeding in excess of 500 ml after the birth of a baby, accounts for the majority of hemorrhage cases and occurs in over 10% of births, with a 1% case-fatality rate. Maternal anemia, which affects up to half of all women globally, has long been purported as an underlying risk factor for PPH, and this assertion has been recently supported by evidence in Africa.

A major gap exists between what is known – the evidence base for effective maternal and neonatal health (MNH) – and what is practiced, especially in low- and middle-income countries. Interventions that can effectively close this gap in these settings depend on community engagement, reliable health systems, and effective leadership. Over the past four years, the Malawian NGO, MaiKhanda, has tested ways to improve health system effectiveness for MNH.

In Uganda, each year an estimated 6,000 women and 35,000 infants die from childbirth related complications. Access to skilled health care and appropriate technologies can save many lives. But in many countries, the difference between life and death for is dependent upon reliable light and electricity. Without that, health workers cannot provide life-saving care. Midwives struggle to deliver babies by candlelight, life-saving procedures are attempted by flashlight, and patients suffer delays in care or are turned away from health centers unable to function in darkness.

Over 24 months with $250,000 in seed funding Partners for Development (PFD) will develop an innovative model to ensure access to ante/postnatal and delivery care (ANC/PNC) in 25 underserved villages in northeastern Cambodia: a transportation system of private sector providers in partnership with local government. To increase demand for such transport and make the system financially sustainable, routes will include schools, markets and other popular destinations in addition to health facilities.

HIV infection accounts for 9% of deaths of pregnant women in sub-Saharan Africa (42.5% in South Africa) and substantially hinders progress towards reducing maternal mortality. HIV infection during pregnancy also contributes to poor perinatal health outcomes (stillbirth, preterm birth, low birth weight, HIV infection). Poor uptake and delayed initiation of antiretroviral interventions are the principal determinants of HIV infection of infants and HIV-related maternal deaths.

In Bangladesh, 77% of births occur outside a facility and 72% without a skilled attendant. When maternal or neonatal complications occur, <40% of women seek care, mainly due to misunderstanding of complication severity and/or necessity for referral; relatives or neighbours are the primary referral sources. Antenatal care coverage and logistical preparation for childbirth emergencies are also poor. An intervention to empower mothers and layperson referral gatekeepers to overcome these logistical, knowledge, communication gaps is urgently needed.

A long-entrenched problem in Pakistan is that the poorest women are unable to access functioning health-centres owing to difficulties in physical access, cost constraints, lack of staff and socio-cultural barriers to travelling. In rural areas 75% births take place at home in unhygienic conditions under the supervision of traditional birth attendants. Therefore, neonatal infections are contracted during and immediately after delivery.Clean birth kits (CBKs) are scientifically proven to enable safer home births by preventing life threatening neonatal infections.

Optimal care during childbirth in rural areas of most low and middle income countries is hampered by 2 major problems: the limited equipment and capacity of health workers for diagnosis, and the quasi-absence of back-up from the hospital, which impacts on their motivation and competence. In order to improve the technical quality of care and the motivation of primary care maternity staff working in rural areas of low-income countries, the Ultrasound4Africa project proposes to develop a two-pronged integrated intervention:

A major cause of maternal and neonatal death and severe disability in developing countries is the lack of trained medical providers to perform emergency cesarean sections in cases of obstructed labor. Due to the shortage of doctors, many underserved countries rely on midwives and clinical officers to provide obstetrical care. These providers are not trained to perform cesarian section. A low cost method for training them to safely do this operation could reduce maternal/fetal mortality and devastating, non-lethal obstetrical complications such as recto-vaginal fistulas.

Elimination of mother-to-child transmission of syphilis and HIV directly contributes towards attaining Millennium Development Goals 4 (neonatal health), 5 (maternal health), and 6 (HIV prevention). However, in 2010, only 68% of pregnant women in low-and middle-income countries were tested for syphilis, and only 35% were tested for HIV. As a result, syphilis contributed to 440,000 stillbirths and neonatal deaths in 2008, and 390,000 children were newly infected with HIV in 2010.

This consortium will test a set of empowerment innovations for pregnant women through Safe Motherhood Solidarity Groups on Idjwi Island in Democratic Republic of Congo focusing on three strategic interventions: 1) Providing women with financial autonomy through the creation of community insurance programs that will enable access to all needed services for mothers and newborns in health centers, 2) enabling communities to actively design feasible, home-based maternal and neonatal assessment tools to monitor outcomes through the implementation of a participatory communication model, and 3) tr

Women in rural areas lack access to affordable, quality health prevention and treatment services. The absence of health treatment and prevention strategies partnered with harmful local customs discourages positive health outcomes. HealthPartners community-owned, sustainable health coop model empowers local stakeholders to partner for increased access to care and improved health outcomes. This is critical for reducing barriers for pregnant women to seek antenatal care, delivery with a skilled health professional and to receive critical follow up care immediately after birth.

Based on ten years of operation in Tibet, One Heart Worldwide (OHW) has developed Network of Safety an effective, replicable and sustainable training and outreach model to prevent maternal and newborn death associated with pregnancy and delivery among remote rural populations. The Network of Safety is a culturally adaptable program that teaches basic life-saving skills to all the community members and health care providers surrounding a new mother and her infant. In 2008, the program reached a sustainable level and was successfully transferred to local partners.

In a non-traditional partnership between non-profit and private sector, Catholic Relief Services is joining with technology innovator Dimagi and training leader Hesperian Foundation to improve maternal well-being and reduce newborn death by up to 50% in Uttar Pradesh, India. The ReMiND Project will accelerate the delivery of proven interventions within the first 48 hours of life through a novel combination of technology, training, and services for health workers and parents, including:  

Shortage of medical resources in rural Uganda leads to inconsistencies in provision of antenatal care (ANC) interventions. Mbarara University and Ibanda district health team propose to enhance delivery and uptake of ANC interventions by harnessing the power of cell phone technology widely available in rural Uganda. We aim to increase the demand for ANC with a pictorial Antenatal Intervention Demand Card (AID-Card) that will be linked to a cell phone data capture and surveillance system. The pictorial representations in the AID-Card will be developed in consultation with the community.

We propose to develop a low-cost scalable mechanism for south-south collaboration among developing country frontline providers, using social networking technology to significantly expand the use of evidence-based practices known to reduce maternal and perinatal deaths. This project capitalizes on the success of the Global Voices for Maternal Health Project that has created, in eight months, a unique network of 2,500 engaged nurses, midwives and doctors working in 900 health facilities located in 99 developing countries, who provide care to over 3,000,000 births a year (see map).

Haemorrhage accounts for up to a third of maternal deaths; safe blood is too often unavailable. As the letter of support from the CEO of one partner, the National Blood Service of Zimbabwe (NBSZ), notes: "As 40% of all blood supplies are given to mothers, shortage of blood seriously contributes to maternal mortality."

Malaria affects over 50% of the populace in sub-Saharan Africa, and contributes to over 200,000 newborn and 10,000 maternal deaths annually worldwide. In 2008, maternal sepsis accounted for 36,000 deaths while neonatal infection caused close to a million neonatal deaths. It is estimated that between 10-30% of drug sales are counterfeit in parts of Africa, Asia, and Latin America - and between 30-50% of all anti-malarials are substandard.

Deaths from PPH, eclampsia, infection and obstructed labour are the major obstacles in achieving MDG5; and infection, birth asphyxia and low-birth weight are for MDG4 in resource poor countries in Asia and Africa. These deaths are preventable, but, treatments along with functional health system are not always available and accessible in these countries. However, low-cost evidence-based solutions implementable at community level are available to prevent mortality from these causes.

Rationale: A lack of staff and equipment, travel, and traditional practices cause 46% of Cambodian women to deliver at home. Addressing these issues will take many decades, so in the meantime a new approach is needed that can be implemented with existing resources.

Rationale: Improve perinatal outcomes by fully utilizing existing resources and raising quality of services by implementing standardized perinatal care to prevent and manage complications of labor and delivery (stillbirth, prematurity, obstructed labor).

Approach: Introduction of concise evidence-based care algorithms to improve service delivery that are rapidly adapted to local conditions to directly address entrenched challenges in the adequacy and timeliness of care for immediate threats to mothers and newborns.