Feb 2013 – Nov 2017

Improving Maternal and Newborn Health Care in Ethiopia

Ethiopia

Country

Ethiopia – Africa

To strengthen and support the Ethiopian Federal Ministry of Health to scale up high-impact maternal, newborn and child health interventions to reduce maternal and neonatal mortality.

$11,900,387 Multi-Year Grant Value

This programme supports the Ethiopian Federal Ministry of Health to test innovations for improving maternal, newborn and child health (MNCH) in low performing areas of the country and to scale evidence-based MNCH interventions through the Health Extension Programme.  Ongoing research supports the government to identify whether innovations are working, course correct, and provide evidence to scale elsewhere in the country.

The strategy for quality improvement in health facilities is Senior Midwife Mentoring: experienced midwives mentor and train health providers in reproductive, maternal, newborn and child interventions. They also use simple tools such as checklists to improve the quality of care.

Impact

The WHO Safe Childbirth Checklist was adapted to fit the unique context of Ethiopia and was first introduced by the government in 123 health centres in 25 pilot woredas or districts in 2015. Phase two expanded the initiative to cover another 75 woredas. 

Ethiopia Checklist Map

In the first three years the programme has now reached 100 woredas, training more than 4,000 health extension workers (HEWs) on community-based newborn care. HEWs receive performance reviews and clinical mentoring, supporting them to improve their data recording and skills in identifying, classifying, treating and referring sick children.

Research on the first 25 woredas to receive clinical mentoring by senior midwives led to improvements to the model, and launch of a new government strategy. To learn more, download the Senior Midwife Mentoring in Ethiopia two-pager below.

In August 2016,  CIFF supported a learning visit by the Ethiopian Ministry of Health to Rajasthan, India to study the first at-scale implementation of the Safe Childbirth Checklist. 

Sharing Expertise Across Programmes

The WHO Safe Childbirth Checklist is one of the tools Ethiopia is using to improve the quality of care women and babies receive during childbirth. This simple tool prompts health workers to follow 29 essential activities at key moments before, during and after birth.  In August 2016, a team from the Ethiopian Federal Ministry of Health made a study visit to Rajasthan, India. 

The aim was to study quality improvement initiatives being undertaken in health facilities in Rajasthan where since 2012, the Government of India, with support from Jhpiego, has successfully introduced the checklist in health facilities. Preliminary data from the project shows a significant fall in early perinatal mortality, along with improvement in 28 out of 29 essential practices. The Government has since launched the national Dakshata initiative, applying the WHO Safe Childbirth Checklist as a framework for improving the skills of health workers, prioritising resource availability, improving compliance to safe care practices, and improving use of data for action. 

The Ethiopian team comprised officials from Regional Health Bureaus, the Maternal Health Case Team and Quality Directorate. They were joined in Rajasthan by the government of India, Jhpiego and a representative from Population Services International, who are implementing the WHO-Safe Childbirth Checklist (SCC) in Uttar Pradesh. The Ethiopian team met with service providers to learn about their methodologies for using the WHO-SCC, the challenges encountered with a high delivery load and how to monitor client satisfaction.

They visited labour rooms to understand how a client-centric approach is used to organise services. The team participated in simulation exercises which promoted team-building, as well as improving service providers’ confidence and capability in delivering quality services. The team noticed a number of cultural similarities between India and Ethiopia. This helped them to understand how service providers work in public health facilities in India, in order to draw upon and replicate this expertise in their own work.

Ethiopia plans to embed the WHO Safe Childbirth Checklist within the integrated maternal and newborn card (the record which tracks mother and baby health from antenatal care to postnatal care). The visit to Rajasthan has also inspired the Ethiopian government to adopt other techniques for maintaining health providers’ skills such as on-site drills.

 Dr Ayele, director of the Quality Directorate at Ethiopia’s Federal Ministry of Health explained the decision to adopt these practices by saying, “[we liked the] continued orientation and professional development they are doing with health care providers simulating cases when [they] didn’t have patients” and “[we are] really happy with the checklist – it brings all information into one tool and [you] don’t need additional charts”.