Advocacy & Health Policy: AIM Takes on Maternal Mortality in Malawi

In 2015, an estimated 303,000 women died in childbirth worldwide, and two-thirds of those deaths occurred in sub-Saharan Africa. The risk of mortality and morbidity due to postpartum hemorrhage is one of the most common causes of obstetrical deaths.

As part of President Thomas Gellhaus’ six-point plan to improve the health care of women and children around the world, a pilot project was initiated in Malawi to implement the Alliance for Innovation in Maternal Health (AIM) safety bundles. The program is headed by Joseph Sclafani, MD, a Baylor College of Medicine professor at the Kazmuzu Hospital in Lilongwe, Malawi, who works very closely with Malawi’s Minister of Health to improve their quality of care.

Malawi has a maternal mortality ratio of 634/100,000 live births, ranking 13th highest in the world. At Kamuzu Central Hospital, there were 91 maternal deaths with a hospital MMR of 2,608/100,000 live births in 2014.

In a country that has seen little reduction in maternal mortality over the past ten years, it is clear that an innovative program is needed to reduce maternal mortality. In the United States, several successful programs have addressed relatively high national maternal mortality using tools that incorporate early recognition, rapid response, team training, and continuous quality improvement methodology. The AIM program contains quality improvement tools that have been proven to be effective in high-resource settings and can be modified for implementation in low-resource settings to achieve similar results.

Although the AIM maternity safety bundles represent best practices for maternity care in the United States, they have not been validated in low-resource countries. This pilot program seeks to determine if the materials and processes of the AIM program can be tailored and effectively implemented in sub-Saharan Africa. The project will establish proof of concept for the AIM program at Kamuzu Central Hospital KCH, a tertiary center, and Area 25 Health Center, a high-volume community health center.

KCH has an established expertise and focus in high-risk pregnancies and is staffed by Malawian and international consultants with advanced training in obstetrics and gynecology. Area 25 is a primary care center staffed by midwives and clinical officers with no surgical theater or additional backup expertise.

The project’s steering committee consists of midwives, administrative professionals, two residents, anesthesiologists, anesthetists, and doctors. A safety survey was completed, showing that while awareness of safety protocols is low, participants indicated interest in a team model that could support the AIM bundles implementation.

The pilot project hopes to achieve its goals through use of an integrated, multidisciplinary approach, which includes a number of objectives:

  • Use of drills, simulations, and team training to foster a work environment with health communication
  • Implementation of standardized protocols and checklists within maternity facilities to treat or prevent obstetrical emergencies
  • Use of AIM maternal safety bundles to implement quality improvement initiatives
  • Assessment of the ability to engage patients and family in quality improvement process
  • Use of data to create meaningful process and outcome metrics

Evaluation of the program will take place at scheduled intervals throughout the duration of the program and consist of collection of information about program activities, and characteristics and outcomes to determine the merit or worth of a specific program. Overall implementation of this Monitoring & Evaluation plan will help determine if the project is delivering its anticipated results.

See ACOG’s Global Women’s Health web page to see how you can get involved in international programs. See the What is AIM web page to find out more about the AIM program and how you can participate at your institution.


American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998