Improving Maternal and Newborn Health Care Delivery in Rural Amhara and Oromiya Regions of Ethiopia Through the Maternal and Newborn Health in Ethiopia Partnership

Authors

  • Lynn M. Sibley CNM, RN, PhD,

    Corresponding author
    • Address correspondence to Lynn M. Sibley, CNM, RN, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, Room 268, Atlanta, Georgia 30322. E-mail: lsibley@emory.edu

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  • Solomon Tesfaye MD, MPH,

  • Binyam Fekadu Desta MPH,

  • Aynalem Hailemichael Frew RN, MPH,

  • Alemu Kebede RN, MPH,

  • Hajira Mohammed MSc,

  • Kim Ethier-Stover MA,

  • Michelle Dynes CNM, RN, MPH, PhD,

  • Danika Barry MPH,

  • Kenneth Hepburn PhD,

  • Abebe Gebremariam Gobezayehu MD


Abstract

Introduction

In Ethiopia, rural residence and limited access to skilled providers and health services pose challenges for maternal and newborn survival. The Maternal Health in Ethiopia Partnership (MaNHEP) developed a community-based model of maternal and newborn health focusing on birth and the early postnatal period and positioned it for scale-up. MaNHEP's 3-pronged intervention included community- and facility-based community maternal and newborn health training, continuous quality improvement, and behavior change communications.

Methods

Evaluation included baseline and endline surveys conducted with random samples of health extension workers, community health development agents, traditional birth attendants (TBAs), and women who gave birth the year prior to the survey; pretraining, posttraining, and postintervention clinical skills assessments conducted with health extension workers, community health development agents, and traditional birth attendants; endline surveys conducted with quality improvement teams; and a perinatal verbal autopsy study.

Results

There were significant improvements in the completeness of maternal and newborn health care provided by the team of health extension workers, community health development agents, and TBAs in their demonstrated capacity and confidence to provide care and a sense of being part of a maternal and newborn health care team. There were also significant improvements in women's awareness of and trust in the ability of these team members to provide maternal and newborn health care, in the completeness of care that women received, and in the use of skilled providers and health extension workers for antenatal and postnatal care. In addition, a shift occurred toward the use of providers with a higher level of skills for birth care. Successful local solutions for pregnancy identification, antenatal care registration, labor-birth notification, and postnatal follow-up were adopted across 51 project communities. The number of days between perinatal deaths increased over the duration of the project.

Discussion

MaNHEP was associated with more, and more complete, coverage of maternal and newborn health care and improved perinatal outcomes. The model is adaptable and potentially scalable, as indicated by the pilot test of its integration into the Ethiopian Ministry of Health's newly revised Primary Health Care Unit and Health Extension Program structures.

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