A comprehensive program to reduce maternal mortality in Health Region 1, Northern Thailand: A regional service evaluation with policy implications for Southeast Asia.

OBJECTIVE: To evaluate a nine-component regional program for maternal mortality reduction in Health Region 1 (HR1), Northern Thailand, examining cause-specific mortality outcomes and implementation fidelity across 103 hospitals. METHODS: The present study involved before-and-after service evaluation of routinely collected surveillance data (CE-62 system) for 2016-2018 against a historical baseline (2009-2015) across 103 hospitals in eight provinces (population of approximately six million). Components included the labor strategy (postpartum hemorrhage [PPH]), pregnancy-induced hypertension (PIH) strategy (hypertensive disorders), cascade simulation training (Advanced Life Support in Obstetrics Program [ALSOP]), and the One Province, One Labor Room (OPOL) mobile coordination platform. Rate ratio with 95% confidence interval (CI; Poisson Wald method) and χ2 test for linear trend (Cochran-Armitage) were applied; 14 process indicators assessed implementation fidelity. RESULTS: The maternal mortality ratio declined from 39.2/100 000 live births in 2016 (22 deaths) to 15.9 in 2018 (six deaths), a 59% reduction meeting the national target (rate ratio 0.41, 95% CI 0.16-1.00; P = 0.050; χ2 trend = 4.05; P = 0.044). PPH deaths declined by 87.5%; PIH/eclampsia deaths were eliminated; and indirect deaths fell 67%. All 14 process indicators improved overall between 2016 and 2018. CONCLUSION: A nine-component program was associated with substantial maternal mortality reduction across 103 hospitals without new capital expenditure. The OPOL platform represents a scalable, low-cost model for regional obstetric coordination applicable to middle-income country settings pursuing Sustainable Development Goal Target 3.1.