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 hospital 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 (LMIC), 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 happen.
Positive outcomes should too.
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 in advanced clinical care 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 consistently
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 (LMICs) 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.
Maternal and newborn hospital 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.
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.
Kybele supported the Ghana Health Service to develop, scale, and sustain the Obstetric Triage Implementation Package (OTIP) so that hospitals could quickly identify and treat the highest-risk patients in order of risk acuity.
~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
OTIP is a comprehensive implementation package that embeds risk-based prioritization within routine service delivery. It combines clinical tools (e.g., triage forms and color-coded wristbands), workflow redesign (e.g., designated triage spaces and nurses), and integration into policy, supervision, and quality improvement systems.
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
This approach enables sustained implementation, institutionalization, and scale.
Nationally scaled by the Ghanaian government, OTIP is implemented in over 100 referral facilities covering 230,00 births a year.
An external evaluation by the Institute for Fiscal Studies (IFS) of the national scale-up shows a causal reduction in institutional maternal mortality of 106 deaths per 100,000 deliveries in referral facilities that adopted OTIP. This makes OTIP one of very few health system interventions with causal evidence of maternal mortality reduction at scale.
OTIP is fully integrated into government policy, supervision systems, pre-service education curricula, and public budgets. At scale, recurrent implementation costs fell to just $0.62 per birth. Economic analyses estimated a cost of $738 per maternal death averted and a benefit-cost ratio of 126.7:1.
OTIP demonstrates that large-scale clinical reform can become national policy, national practice, and nationally financed.
