UNIVERSITÉ LIBRE DE BRUXELLES
SCHOOL OF PUBLIC HEALTH
MC in public health methodology programOperational research and planning
Accessing skilled delivery for Ethiopian rural women. A project proposed by:
Azmeraw Tayelgn AMARE (Bahir Dar University, Ethiopia)
Advisor:
Professor Patrick Martiny (Université libre De Bruxelles)
April, 201204/10/23 Community midwives for Ethiopia 1
Presentation outline
Needs-offer-demands frame
Unsatisfactory issue and intervention(Managerial
blocks)
Goal, objective and results
Indicators
Main activities
Gantt Chart
Team: persons involved04/10/23 Community midwives for Ethiopia 2
Needs-offer-demands frame
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•low access and poor quality skilled delivery
•Rural women had low demand and utilization of institutional delivery
Low demandThere is need
Low offer
Unsatisfactory issue:
low access to skilled delivery for rural Ethiopian women Only 4.1% of rural mothers were delivered at health care facility (EDHS, 2011)
In 2011 the maternal mortality rate in Ethiopia is 676 per 100,000 live births (EDHS, 2011).
The lack of functioning maternal health care facilities is severe in rural parts of the country.
Definition of the intervention• Introduction of a Community midwives with access
to ambulance for emergency referral4
1. Unsatisfactory issue and intervention
04/10/23 Community midwives for Ethiopia
Managerial blocks
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Next slidesNext slides
Managerial blocks1. Leadership & Governance• No maternal health policies• Little coordination of maternal health care activities• Low political commitment to maternal health care
2. Resources
Infrastructure & Supplies• Poor infrastructure in the rural areas• Low access of the health care system• No electricity• Lack of roads or poor condition of roads• Lack of emergency transportation• Shortages of supplies, i.e. emergency medicines• Lack of equipment for obstetric care
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Managerial blocks con…
Human Resources
• Shortage of of healthcare personnel(midwives)
• Poorly trained health workers with punitive attitude
• Lack of community support
• Gender insensitivity of healthcare providers
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Managerial blocks con…Knowledge &Information• There are inadequate and inaccurate data to
evaluate maternal health care• There is no continuous maternal health care
monitoring system• Rural mothers do not access to communication.• Most of the rural women are illiterate
Finances • There are global maternal health care funds
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Managerial blocks con…
3. Organization and delivery of health care
• The maternal health care facilities are poor in
quality and poorly utilized
• The first line health care unit is poorly structured
and less equipped to provide the appropriate care.
• Weak referral system which includes poor
transportation and poor communication
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Managerial blocks con…4. Population Interaction with population • There is less demand of using the health care
system• Low participation of the community• Women are less informed about their health needs• Local, community and religious leaders are
influential to bring social change
5. Values & Principles• Women have the right to health care• Women have the right to autonomy and security • But the health care system poorly focus on the
participation of clients.04/10/23 Community midwives for Ethiopia 10
Managerial blocks con…
6. Context• There are international organizations working for
improving maternal health care• The international policies and goals gave priority
to maternal health care• Improving maternal health is one of the
millennium development goals• International political, environmental realities
support maternal health care• There is increased donor funding for maternal
health care
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Goal: Improving maternal health condition of
Ethiopia
Outcome: Reducing maternal mortality rate in the
country
Results: Increased proportion of rural mothers
whose delivery will be assisted by skilled birth
attendants
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2. Goal, objective and results
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Goal At the end of 2016, the maternal morbidity and
mortality in the Ethiopia will be reduced by half. Outcome At the end of 2016, the maternal mortality rate in the
country will be about 338 per 100,000 live births.Results At the end of 2016, more than 50% of deliveries will
be attended by community midwives At the end of 2016, more than 70% of rural mothers
delivery will be attended by skilled birth attendant At the end of 2016, about 5% of mothers will be
referred to hospitals for emergency intervention13
3. Indicators
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4. Main activitiesActivity 1:Training of community midwives
To communicate with universities and colleges Design teaching curriculum To select the trainee Training Assignment of trained midwives
Activity 2:To buy and make ambulances ready for emergency transport to district hospitals.
Activity 3: To equip the health posts with basic emergency obstetric care equipments
Activity 4:To organize mother-help task force in each kebele for supporting pregnant women in emergency situations.04/10/23 14Community midwives for Ethiopia
Mains activities con...Activity 5:To teach households/families to
recognize the importance of skilled birth deliveryActivity 6:To train and empower religious and
community leaders to work with community midwives
Activity 7:To organize informational campaigns to heighten community awareness of the benefits of seeking skilled care
Activity 8:To evaluate the program every year and at the end of the project
Activity 9:To provide continuous education, on job training and positive supervision/support for the midwives
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5. GANTT CHART
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YearActivities 2012 2013 2014 2015 2016
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5
Activity 6
Activity 7
Activity 8
Activity 9
04/10/23 Community midwives for Ethiopia
National Safe motherhood team
• The team consists of head of MCH department from the
ministry of health, women representatives from ministry of
women, representatives from colleges and Universities,
experts from Ethiopian obstetrics and gynecology association
and from Ethiopian midwifery association.
Regional Safe motherhood team
• The team consists of head of MCH department from regional
health bureau, representatives from regional health science
colleges and consultant physicians from the regional
hospitals. 17
6. Team: persons involved
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Team: persons involved
Committee at the district level
• Head of the wereda health office, Head of the
district hospital, and head of the health center.
Committee at the kebele(Community) level
• Active and operational team which consists of
kebele leaders, community midwives, and
representatives from the community (community
leaders or religious leaders)
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Thank you!!!
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