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This manual offers a strategy for program design and evaluation of maternal mortality prevention programs in developing countries and identifies required knowledge a program design monitoring and evaluation and information dissemination. The manual aims to share some lessons learned and to increase institutional capacity. It offers a way for local personnel to think about project design and evaluation rather than providing a simple set of instructions. The target audience includes specialists in maternal mortality and program planners and managers at the local or district level. The manual is also useful at the state or national level. It was developed for and tested by the Prevention of Maternal Mortality Network (PMMN) at Columbia University and 11 teams in West Africa that carried out operations research in Ghana Nigeria and Sierra Leone. Three principles are central to the development approach. The PMMN ended in 1997. The African teams now share their technical experience and expertise with other African colleagues. All interventions to reduce maternal mortality should reduce the likelihood that a woman will become pregnant will experience a serious complication of pregnancy or childbirth and will die due to serious complications. The manual focuses on reducing the number of deaths from serious pregnancy complications. The largest number of maternal deaths occurs among women aged 20-29 years who have the smallest relative risk. Women need access to emergency obstetric care and prevention of delays in seeking reaching and receiving care. Interventions must record process and output data. Information is needed on the availability of life-saving services the number of women using life-saving services the number of life-saving procedures performed the quality of care the methods for improving services the methods for improving use of services and the costs of improving existing services that provide emergency obstetric care.