Outcomes of a SAFE MOTHERHOOD PROJECT IN ETHIOPIA 20002004, supported by Gates Foundation and USAID

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Outcomes of a SAFE MOTHERHOOD PROJECT IN
ETHIOPIA 2000-2004, supported by Gates
Foundation and USAIDSUSTAINABILITY - Two years
later

• CARE INTERNATIONAL IN ETHIOPIA
• October 18, 2007
• Frehywot Eshetu, MD, MPH
• SRH program manager

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Health Indicators

• Maternal mortality rate
• 673 maternal deaths per 100,000 live births
• Anti-natal care coverage (ANC)
• last pregnancy - 28
• Skilled delivery
• 5 births attended at health facility
• 94 births delivered at home
• 1/3 attended by a traditional birth attendant
• Post-natal care coverage (PNC) 5

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Project Overview

• Objective
• To improve access, quality utilization of
  emergency obstetric care services
• Strategies
• Health Facility Improving the accessibility
  quality of basic comprehensive EMOC services
• Renovation, provision of supplies, trainings (
  emergency obstetric care, Infection prevention,
  communication)
• Improving documentation and reporting
• Development Maternal death review committee and
  emergency response team

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Project Overview

• Strategies
• Community Increasing service accessibility and
  improving the Obstetric service utilization
• Training of TBAs, case review b/n TTBAs and
  midwifes
• Project sites in Ethiopia
• 3 hospitals in Oromia Region,
• 2 sites included a community component

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Problems addressed by the project

• Poor quality of service provision
• Lack of basic obstetric care services ( un
  availability of drugs, supplies, trained man
  power)
• Service Inaccessibility
• Poor health care seeking behaviour
• Poor client provider communication
• Unfamiliarity of hospital environment
• High cost of treatment- Transportation
• High case fatality rate

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Outcome of the EMOC project

• Increased utilization of Emergency Obstetric Care
• Improved availability and quality of the
  emergency obstetric services
• TTBAs mobilize the community for financial and
  human power to transport the laboring woman to a
  facility
• Increased Client Satisfaction with Facility Care
• Trained TBAs, became a major source of
  information for clients in guiding through the
  facility

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Outcome of the EMOC project
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Outcome of the EmOC project

• Decreased use of traditional birth related
  practices by TBAS
• I used to do abdominal massage for labouring
  mothers and give herbal medication when labour
  prolongs but now I have stopped this practice
  after I got training
• Improved Collaboration between TBAs and
  Facilities
• In the last quarter of the project period, 701
  mothers assisted by TTBAs, 35 referred

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Outcome of the EMOC project
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Lessons Learned

• Promoting community participation and creating a
  linkage with the facility level intervention is
  an effective approach
• The role of TTBAs in promoting the health service
  utilization by the community by increasing the
  level of trust on the health facilities, is
  appreciated
• Respecting the basic rights of mothers , such as
  privacy, choice of labor position, having a
  support person present during labor/delivery has
  a key role in increasing institutional deliveries
  
• Existence of Emergency response team (ERT) and
  Maternal Death Audit (MDA) in the health
  facilities contributes a lot in quality
  improvement

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Sustainability

• Facility Intervention
• Two of the hospitals ( Adama Gelemso) are
  currently providing EMoc service, one of them
  training center for EMOC
• The facilities are using proper Infection
  prevention techniques
• Basic supplies for EMOC are available but there
  is occasional interruption

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Sustainability

• Community Intervention
• TTBAs are still doing the home delivery and
  accompany mothers to facilities but supervision
  and reporting is discontinued
• Review meeting between the TTBAs and health
  professionals is discontinued
• Maternal Death Audit is no more done
• Registration and documentation of obstetric data
  is being done

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Sustainability

• A TTBA said that
• Even though am not paid in cash for the job, my
  salary is the number of maternal lives that I
  saved so far. The recognition and respect I got
  from the community also motivates me to continue
  being a volunteer as long as am fit for the work

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Outcome of the EMOC project

• Challenges
• The high staff turn over in the health facilities
  
• Failure to include the surrounding health centers
  in the intervention
• Lack of government capacity to take over the
  project activities
• Health system structure hinders collaboration b/n
  hospital and health centers

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I Thank you