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 χ 2 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; χ 2 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.