NEJM: What We Can Do about Maternal Mortality - And How to Do It Quickly in USA

1 November, 2018

We read this perspective article in NEJM and found it very interesting: money is important in providing health care but it takes more than that to strengthen health systems for quality and safe outcome. We found that this article rhymed with the message that so eloquently was illustrated during the Alma Ata and PACK Congress in Cape Town South Africa on 25th and 26th October 2018 organised by the Knowledge Translation Unit of University of Cape Town, that the 4-Pillars of the PACK Programme for PHC (PACK Guide, Facility Readiness, Onsite Inservice Training, Mentoring and Evaluation) when applied together in tandem is helping country after country where PACK programme is implemented, like Nigeria, to improve clinical competence, outcome, etc, and potentially will save lives and yield economic gains that could be re-cycled into the system - a positive cost-efffective cycle health system.

READ ON courtesy of NEJM -

What We Can Do about Maternal Mortality - And How to Do It Quickly

Susan Mann, M.D., Lisa M. Hollier, M.D., Kimberlee McKay, M.D., Haywood Brown, M.D.

November 1, 2018 N Engl J Med 2018; 379:1689-1691 DOI: 10.1056/NEJMp1810649


'Most Americans take for granted that giving birth in a U.S. hospital will be a safe experience resulting in a healthy mother and baby. However, recent reports in the lay media -- an NPR special series called “Lost Mothers: Maternal Mortality in the U.S.”; a New York Times article on closures of rural maternal services; and a USA Today series, “Deadly Deliveries” - ddiscuss increasing maternal mortality in the United States and the significant concern it presents for childbearing women and their families.

Women in the United States are more likely to die from childbirth - or pregnancy-related causes than women in any other high-income country...

So how can the health care community reverse the devastating trend in pregnancy-related deaths? We recommend four actions that can be adopted by every hospital providing obstetrical care, regardless of its size.

First, hospitals can expand their focus on the preventable causes of obstetrical complications and related death...

Second, all hospitals can implement multidisciplinary staff meetings or huddles to assess and review each obstetrical patient’s risk factors...

Third, staff can simulate obstetrical emergencies in the labor and delivery unit...

Fourth, hospitals can use the Maternal Health Compact. The compact ensures readiness by formalizing existing relationships between lower-resource hospitals that transfer pregnant women when they require higher levels of maternal care and the referral hospitals...

More broadly, we recommend that ACOG and the American Academy of Family Physicians collaborate on an additional year of comprehensive training for family medicine physicians who are considering practicing obstetrics in rural areas...

The essential goals of the maternal safety movement are to improve responses to signs of worsening clinical status of pregnant or postpartum women and to ensure that all clinicians and birthing facilities provide high-quality care. Creating a culture of safety in all birthing facilities while promoting and providing a supportive patient-centered environment for mothers is a critical task that requires strong administrative and clinical leadership, adequate resources for training, and a quality-improvement feedback system in which the entire health care team is held accountable for system changes. If we’re to achieve such a culture, hospital leadership will need to create a vision for change by establishing relationships with referring and receiving hospitals, including by deploying telehealth resources. Leadership can provide resources for staff to implement team training and perform simulations to practice their skills and confirm that necessary resources are available for emergencies. If leaders hold their staff and themselves accountable, they can curb the trend of increasing rates of preventable maternal deaths.'


As USA is experience increased maternal mortality the country we believe is responding with solutions that mirror the 4-Pillars of the PACK Programme for PHC (PACK Guide, Facility Readiness, Onsite Inservice Training, Mentoring and Evaluation).

Joseph Ana.

Lead Senior Fellow


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and Periodicals.

Nigeria: 8 Amaku Street, State Housing & 20 Eta Agbor Road, Calabar.

Tel: +234 (0) 8063600642

Website: email: ;

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

jneana AT