Improving Coverage of Postnatal Care in Rural Ethiopia Using A Community-based, Collaborative Quality Improvement Approach


  • Solomon Tesfaye MD, MPH,

    Corresponding author
    • Address correspondence to Solomon Tesfaye, MD, MPH, University Research Co., LLC, Bole Medehanealem Roundabout to Bole Road, Addis Ababa, Bole Subcity, Ethiopia. E-mail:

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  • Danika Barry MPH,

  • Abebe Gebremariam Gobezayehu MD,

  • Aynalem Hailemichael Frew RN, MPH,

  • Kim Ethier Stover MA,

  • Hana Tessema RN,

  • / Lamesgin Alamineh MPH,

  • Lynn M. Sibley CNM, PhD, RN



Ethiopia has high maternal and neonatal mortality and low use of skilled maternity care. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), a 3.5-year learning project, used a community collaborative quality improvement approach to improve maternal and newborn health care during the birth-to-48-hour period. This study examines how the promotion of community maternal and newborn health (CMNH) family meetings and labor and birth notification contributed to increased postnatal care within 48 hours by skilled providers or health extension workers.


Baseline and endline surveys, monthly quality improvement data, and MaNHEP's CMNH change package, a compendium of the most effective changes developed and tested by communities, were reviewed. Logistic regression assessed factors associated with postnatal care receipt. Monthly postnatal care receipt was plotted with control charts.


The baseline (n = 1027) and endline (n = 1019) surveys showed significant increases in postnatal care, from 5% to 51% and from 15% to 47% in the Amhara and Oromiya regions, respectively (both P < .001). Notification of health extension workers for labor and birth within 48 hours was closely linked with receipt of postnatal care. Women with any antenatal care were 1.7 times more likely to have had a postnatal care visit (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.10-2.54; P < .001). Women who had additionally attended 2 or more CMNH meetings with family members and had access to a health extension worker's mobile phone number were 4.9 times more likely to have received postnatal care (OR, 4.86; 95% CI, 2.67-8.86; P < .001).


The increase in postnatal care far exceeds the 7% postnatal care coverage rate reported in the 2011 Ethiopian Demographic and Health Survey (EDHS). This result was linked to ideas generated by community quality improvement teams for labor and birth notification and cooperation with community-level health workers to promote antenatal care and CMNH family meetings.