Bulletin of the World Health Organization
Volume 93, Number 6, June 2015, 361-436
http://www.who.int/bulletin/volumes/93/6/en/

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EDITORIALS
The Sendai framework: disaster risk reduction through a health lens
Amina Aitsi-Selmi & Virginia Murray
doi: 10.2471/BLT.15.157362

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Research
Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania
Ulrika Baker, Stefan Peterson, Tanya Marchant, Godfrey Mbaruku, Silas Temu, Fatuma Manzi & Claudia Hanson
Abstract
Objective
To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania.
Methods
Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi’s model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care.
Findings
Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts.
Conclusion
The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context.

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Policy & Practice
Applying the lessons of maternal mortality reduction to global emergency health
Emilie J Calvello, Alexander P Skog, Andrea G Tenner & Lee A Wallis
Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions.