1. at least 35,000 deliveries at participating centres performed by qualified healthcare personnel
2. at least 950 birth complications are avoided through preventive examinations
3. at least 48,000 prenatal ultrasound examinations performed
   
    

1. Further training for the medical staff of 34 health centres    
2. Further training of 100 community health workers for population-based sensitisation regarding prenatal care and the signs of impending birth complications     
3. Establishment of a "revolving fund" to ensure the supply of essential medicines.
4. Ensuring cost transparency for services and medicines at participating centres through contractual pricing according to national guidelines, public tendering of prices at the centres and communication of fixed prices by community health workers    
5. Establishment of a programme for the pro rata assumption of costs for medical care for pregnant women at participating centres.
6. Implementation of monthly mobile screening and ultrasound examinations for pregnant women at 34 health centres, carried out by trained midwives from Doctors for Madagascar. 
7. Operation of three all-terrain ambulances that cover 34 basic health centres and can transfer patients to one of the three reference hospitals in the event of obstetric emergencies. 
8. Weekly health education of the population on maternal health issues by 100 community health workers through i) home visits; ii) focus group discussions, or iii) mass awareness campaigns    
9. Establishment of a referral system for pregnant women with potential obstetric complications from community health workers to secondary care referral hospitals for delivery. 
10. Mixed-methods study with randomised controlled trial design to investigate the role of ultrasound examinations as an incentive to seek skilled care during childbirth.

Our sustainability approach is geared towards the long-term strengthening of existing local structures and resources by focussing on the consistent expansion and promotion of local capacities. We invest in the training of staff who are not only responsible for the project, but also for ensuring general healthcare in the project region. 
The implementation of revolving funds is a proven measure in Madagascar that contributes to the long-term financial security of health centres. These revolving funds will also have a long-term positive impact on the financing of health centres and the availability of vital medicines after the end of the project period.

This project was developed in close cooperation with representatives of the Madagascan Ministry of Health and is based on a successful multi-year partnership. 
The project works directly with the existing structures of the public and church health system in southern Madagascar and deliberately avoids the creation of project-based parallel structures.