title: Making EmOC a reality--CARE's experiences in areas of high maternal mortality in Africa.
abstract: OBJECTIVE
  This paper describes the package of interventions undertaken by the CARE/AMDD program collaboration to increase the availability and quality of emergency obstetric care for 3 high maternal mortality countries in Africa.
  
  
  METHODS
  Project implementation over 4 years focused on enhancing the capacity of 10 district hospitals in 3 countries - Tanzania, Rwanda and Ethiopia. Interventions were designed to create functional health facilities with trained and competent staff, working in an enabling environment supporting EmOC service delivery.
  
  
  RESULTS
  By keeping a clear focus on EmOC, the project achieved modest improvements in services, even in the face of the considerable constraints of rural district hospitals. Availability and utilization of EmOC increased in Tanzania; the met need for EmOC increased slightly from 14% in year 1 to 19% in year 4, while in Rwanda it increased from 16% to 25% over 4 years. Case fatality rates (CFR) declined by 30-50% in all 3 countries. While still well below UN recommendations, in all 3 countries there was also a progressive increase in the cesarean section rates, a life saving obstetric intervention.
  
  
  CONCLUSIONS
  The increases in met need and decreases in case fatality suggest that project interventions improved the quality and use of EmOC, a critical component for saving women's lives.
authors.affiliation: CARE USA, USA. mkayongo@care.org
authors.forename: M
authors.initials: M
authors.lastname: Kayongo
authors.forename: M
authors.initials: M
authors.lastname: Rubardt
authors.forename: J
authors.initials: J
authors.lastname: Butera
authors.forename: M
authors.initials: M
authors.lastname: Abdullah
authors.forename: D
authors.initials: D
authors.lastname: Mboninyibuka
authors.forename: M
authors.initials: M
authors.lastname: Madili
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000592:standards* / Q000639:trends; D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration; D008428:Maternal Mortality / Q000639:trends*; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D018570:Risk Assessment