1. noviembre 30-diciembre 1 de 2010

2. English Outline Institutional niche working in maternal / RMM in LAC Strategic priorities in maternal health Beneficiaries, geographical areas and key partners of this work Major challenges and opportunities for work in 2011-12 RMM How can the work of GTR help address these challenges and build on the opportunities identified?

3. Trends In Maternal Mortality 1990-2008 Caribbean MMR/100,000 Country Est. 1990 1995200020052008 % annual decline Lifetime risk PMDF LAC140852.9 Bahamas5559564849-0.71:10001.5 Barbados12042506264-3.51:11001.6 Guyana310250 120190270-0.71:1505.7 Jamaica66769187891.71:4503.4 Belize723210094 1.51:3005.6 Suriname8439110100 1.01:4003.8 Tri &Tob86905955 2.5!:11001.7

4. Institutional niche working in maternal / RMM in LAC Caribbean Countries part of the LAC and mandated by ICPD, IATF MMR MMR in the region is on the decline, slow progress (MMR 140/100,000 approximately 17,000 deaths in 1990) 2008 estimates (MMR 85, estimated deaths 9,200) actual annual % change of 2.9. Region classified as making progress. IATF strategies were instructive in developing intervention in high Mortality countries Suriname and Jamaica under EC funded initiative. Very useful strengthen inter agency collaboration, allowed MOH to set strategic objectives to be supported agencies Jamaica- National consultation actively promoted IATF Maternal Mortality Cost- effective interventions for the reduction of the incidence and severity of complications associated with pregnancy, childbirth and the postpartum period. Participating countries T&T, Guyana, Belize and Suriname. Guided development of safe Motherhood strategy 2002 – 20011 Strategic plan in cooperate in 20-30 Vision ( development plan) Influenced programme supported in Suriname 2002- 2007

5. Strategic priorities in maternal health Priorities Special effort to target countries with high rates and slow progress Human resource management, instructional strengthening, Policy development, improve coordination, partnership, strengthen RH commodity security, strengthen FP and SRH Rights. Special intervention (MHTF) in Guyana with the highest MMR Proposed overall strategy for the MH-TF 2009-2011 There are 4 areas of work in this proposal and 4 outputs that will need to be matched against the outputs of the existing County Programme: Human resources for maternal health. Output 1: Human resources for maternal health improved in quantity and quality, training, support, management and status. Focus on Midwives. EmONC ( Emergency obstetric and newborn care Output 2: EmONC strengthened as a system Linkages with Family Planning Output 3: Family Planning Programme and other RH programmes promoted and strengthened, particularly for adolescents Monitoring and Evaluation Output 4: Strengthened management at the central and provincial levels, with a focus on M&E for maternal health

6. Beneficiaries, geographical areas and key partners of this work People of Guyana, women and young girls and their families including Amerindian population Health care provider Coverage National coverage but some support to Suriname in FP PAHO,UNFPA, UNICEF, WB, MOH, Med Association, Midwife & Nursing Association, NGO’s

7. Major challenges and opportunities for work in 2011-12 RMM Political sensitivity of MMR data and Govt. desire to show impressive results Acceptance of Global estimates due to differences with Govt. numbers, need for clarification Incomplete data collection capacity in most countries Distrust of the outsider. Absolute shortage of OBGYN for programme and system leadership H R. Attrition and retention of Staff. Including early retirement 55 yrs.,Supervision by inexperience and untrained personnel, demotivated staff Midwives not authorized to carry out life saving function in some places. No institution provides all 9 signal function over the last 3 months of EmONC survey

8. Challenges Dispersed population – access Geographical access Transforming policy into action Working relations between Dr. and Midwives Very junior assigned in supervisory roles Low institutional capacity Working with political interest to address fundamental issues rather than appear to be doing something.

9. OPPORTUNITIES Work with MOH and OBGYN to host high level symposium to demonstrate technology especially where few doctors wage enormous influence over technological and procedural initiatives. CME Support establishment of regional training facilities where short exposure can be accessed Identify training institution where short assignment can be made to acquire life saving skills Use results of EmONC study as starting point for intervention.

10. OPPORTUNITIES Core team ( inter agency) exist on EMONC Results of survey outline issues no Comp. facility MoH seeking assistance Recent spike in Maternal Deaths President and cabinet shown much interest and will support initiatives MOH seeking assistance of OBGYN at referral government Minister of Health eager to show progress Staff and national outrage at spike in MM May fundraising opportunities to link underlying issues of MM Policies in place but do not make programmers e.g. abortion law but no programme in the public sector Policy on basic package of service but package not available at delivery point, high tech computer programme and supplies at central warehouse but lack of supplies at delivery site

11. How can the work of GTR help address these challenges and build on the opportunities identified ? Capacity building Sharing of best practices Support sub regional conference on MMR Engage academic institutions to strengthen capacity South - South cooperation on Training in life saving skills ( EmONC) Short term assignment of OBGYN to strengthen system in Maternity facilities.

12. How can the work of GTR help address these challenges and build on the opportunities identified Support development and costing of EmONC plan of action. Share knowledge on SHR work with Amerindian population including Maternity waiting home Build on CME support for CME session by expanding local list serve to receive regional technical update.