Mothers and babies are
dying inside the hospitals
meant to save them.
Hospital births have risen across low- and middle-income countries. The promise of safer childbirth remains unrealized.
Kybele partners with governments to strengthen care across the maternal and newborn journey – from admission to discharge – embedding practical solutions into national health systems.
~80%
Reduction in maternal mortality
OTIP – Ghana
IFS independent evaluation
35%
Reduction in perinatal mortality
Stillbirths and newborn deaths
Kybele supported facilities, Ghana
Scaled
Neuraxial anesthesia for cesarean delivery and labor
Serbia – regional rollout
25+
Peer-reviewed publications
15 countries – 4 continents
Independent & Kybele-led research
Where births go, deaths follow -
until systems catch up.
The shift to hospitals has changed where survival is decided.
Countries follow a predictable transition of where births occur – from homes to lower-level facilities, and ultimately to hospitals. Across low- and middle-income countries, over 70% of births now occur in hospitals – yet mortality remains high because hospitals often cannot deliver the necessary care when it matters most.
Survival is not determined by access alone.
It is determined by how care works inside the health system.
Complications are predictable. Outcomes are not.
The gap is not whether care exists. It is whether advanced care works – every time.
This is the moment where quality – not access – determines survival.
And where investment has the greatest leverage.
Clinical excellence. Deep partnership.
Designed for scale.
01
IDENTIFY AND RESPOND
Targeted clinical improvements convert high-risk moments to safe outcomes
02
INTEGRATE
Process gains embedded in standard care reduce mortality consistency
03
SUSTAIN
Low-cost design enables institutionalization without recurrent external funding
04
SCALE
Government-led scale converts facility gains into national mortality reduction
Strengthening care across the
Kybele supports health systems in low-and-middle income countries to develop, embed and sustain improvements that strengthen the quality of care across the full maternal and newborn journey in hospitals – ensuring risks are identified early, care is delivered safely, and outcomes are continuously improved.
Mother & baby journey
from admission to discharge
Referrals & arrival
Triage & monitoring
Antepartum optimization
Labor & theatre
Newborn resuscitation
Postnatal & monitoring
NICU care
Across every stage >> Quality improvement * Leadership & governance * Finance * Data & management * Human Resources * Supplies
Co-designed with the Ghana Health Service.
~80% fewer maternal deaths.
Across low and middle-income countries (LMICs), births are transitioning from homes and lower-level facilities into hospitals, which now account for more than half of births. Despite this, maternal mortality remains high and increasingly, deaths are driven by failures in timely care after arrival at the hospital.
In Ghana, like many LMICs, maternity systems operated on first-come, first-served models rather than clinical urgency, delaying treatment for women with life-threatening complications.
~80%
Reduction in institutional maternal mortality
IFS independent evaluation
110+
GHS Facilities – OTIP national policy
Ghana Health Service, 2024
$0.62
Per birth – absorbed into Ghana’s domestic budget
Program cost data
The Obstetric Triage Implementation Package (OTIP) is a low-cost end-to-end implementation package that insures:
- rapid assessment
- immediate prioritization
- timely management of high-risk cases
650,000
Women reached by OTIP through government-led triage to date
$759
Estimated cost per maternal death averted
126:1
Estimated benefit-to-cost ratio
OTIP combines:
clinical tools + facility workflow redesign + facility champion-led training quality improvement + monitoring & evaluation + governance & policy interventions
This approach enables sustained implementation, institutionalization, and scale.
Nationally scaled by the Ghanaian government, the external evaluation found ~ 80% fewer maternal deaths
An external evaluation by the Institute for Fiscal Studies (IFS) of the national scale-up shows a casual reduction in institutional maternal mortality
of 106 deaths per 100,000 deliveries.
