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Indicators and benchmarks for tracking progress towards Safe Motherhood

Project team: Sabine Gabrysch

External collaborators: Oona Campbell, Philipp Zanger, Harshalal Seneviratne, Reuben Mbewe

Funding: Core funding 

Millennium Development Goal 5 is off track. Substantial efforts are being made to measure maternal mortality, but as this is costly where routine data are of insufficient quality, it is not measured frequently enough to track quick changes. The indicator of skilled attendant at birth, as gathered from household surveys, has been criticised for not capturing quality of care and therefore not aligning well with maternal mortality.

Indicators of health-system outputs, namely Emergency Obstetric Care facilities, staff and their geographic distribution, have great potential to serve as monitoring tools towards achieving MDG5 as they can guide interventions. Most of the annual 225 000 maternal deaths (as well as many of the 2 million neonatal deaths and stillbirths) estimated to be intra-partum related, could be prevented if women had access to Emergency Obstetric Care. Yet despite their potential, output indicators are currently underused.

We take advantage of existing national health facility data from Zambia (a high maternal mortality country) and Sri Lanka (a low maternal mortality country), to demonstrate how health-system output indicators can be studied and used to better understand the health system’s potential contribution to preventing maternal mortality. We compare national and subnational density of health facilities, EmOC facilities and health professionals against current benchmarks for Zambia and Sri Lanka. For Zambia, we furthermore examine geographic accessibility by linking health facility data to population data.

Our study highlights that current health-system output indicators and benchmarks proposed by the WHO and other UN agencies may need some revision to make them consistent and more practically useful. Increased use of an improved set of output indicators could make an important contribution in guiding international efforts towards reducing maternal mortality.


Collender G, Gabrysch S, Campbell OMR. (2012): Reducing maternal mortality: better monitoring, indicators and benchmarks needed to improve emergency obstetric care. Research summary for policymakers. Tropical Medicine and International Health, 17(6):694-696.

Gabrysch S, Zanger P, Campbell OMR. (2012): Emergency obstetric care availability: A critical assessment of the current indicatorTropical Medicine and International Health, 17(1):2-8.

Gabrysch S, Zanger P, Seneviratne HR, Mbewe R, Campbell OMR. (2011): Tracking progress towards safe motherhood: meeting the benchmark yet missing the goal? An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka. Tropical Medicine and International Health, 16(5):627-639.