national rollout to strengthen basic emergency obstetric and newborn care in ethiopia. tyigzaw....

7/23/2019 National Rollout to Strengthen Basic Emergency Obstetric and Newborn Care in Ethiopia. TYigzaw. FIGO2012

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Supporting the National Rollout toStrengthen Basic Emergency

Obstetric and Newborn Care inEthiopia: Collaborative ProjectTegbar Yigzaw, Hannah Gibson, Alemnesh Tekleberhan,Moltotal Mekuria, Mintwab Gelagay, Abdo Bedru, AmarechGashaw, Tadele Bogale, Nega Tesfaw, Hone Belete


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Presentation Outline

Background

Project Description

Results Challenges and Lessons Learned

Conclusions

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I. Background

Population: 87 million (PRB, 2012)

MMR: 676/100,000 live births (CSA, 2011)

Skilled attendance: 10 % (CSA, 2011) Only 10 % of facilities met criteria for fully

functioning EmONC services (MOH, 2008)

Facilities lacked essential equipment and/or skilledproviders

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II. Project Description

Reduction of maternal mortalityby strengthening provision of

BEmONC 2 year program (November

2010-June 2013)

Guided by Ministry of Health

and Regional Health Bureaus

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FMOH


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III. Result 1: Establish 15 BEmONC Training

Sites

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Selection 15 hospitals identified based on selection criteria

Assessment 14 of the 15 hospitals assessed

Skillsstandardization

Facility providers trained in BEmONC

10 of the 15 hospitals used as training site

Infrastructurestrengthening

Training materials (anatomic models, midwifery kits

and training facilities) provided to 7 sites


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Result 2: Develop 64 National BEmONC

Trainers Training of trainers

course for 65

providers 16 Midwifery

Association trainers

50 co-trained in

BEmONC courses

Skills standardization

Trainingskillscourse

Mentoredco-trainingexperience

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Trainer development pathway


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Result 3: Training 2000 Providers in BEmONC

82 rounds of BEmONCtraining conducted

24 by Jhpiego and 58 byMidwifery Association

1289 (64.5 %) providerstrained

Post-training phone follow-up of 390 trained providers

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Findings of Phone Follow-up

Most reported they were providing competentBEmONC services

58.7 % and 21.4 % reported lack of essentialequipment and drugs

MVA, newborn resuscitation equipment

MgSO4, Oxytocin, parentral antibiotics

Need for onsite supervision

Low caseload

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Result 4: Strengthen BEmONC in Hospitals

and Health Centers Performance and quality

improvement initiated in 6

hospitals 1st and 2nd module

workshops conducted

45 Px each (6-9 per facility)

Assessments and gapfilling interventions done

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Essential Maternal and Newborn Care

Standards for HospitalsAreas # Standards

Antenatal Care 5

Normal Labor, Childbirth and Immediate Newborn Care 10

Postpartum Care 4

Management of Obstetric Complications 9

Infection Prevention 14

Laboratory 12

Pharmacy 4Human, Physical and Material Resources 8

IEC and Community Participation 6

Management Systems 7

Total 79 10


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Baseline and Internal Monitoring

Assessment Findings (%) in 5 Hospitals

36

2733

68.9

51.9

0

45 52

0

57.3

0

10

20

30

40

50

60

70

80

Assosa Pawie Gambella Karamara Godie

Baseline

Internal Monitoring

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IV. Challenges and Lessons Learned #1

Frequent discussions with MOH, RHBs, UNICEFand EMA helped to identify and resolve

implementation challenges promptly Partnership with EMA contributed to strengthening

local capacity and cost-effective training cascade

Phased approach and PQI to address low

caseload and lack of equipment

Engaging facility providers as co-trainers helped toimprove their cooperation

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Challenges and Lessons Learned #2

Resource and labor intensive training (6 coursesper month, 3 wks duration, 4 trainers)

Develop more trainers, pilot blended course (2 wks) Resource and distance barriers to post-training

support and follow-up

Phone follow-up and support

Trained regional MNH focal persons on supervision

Assuring BEmONC training quality nationally

Standardized national training package

Training of trainers, training site establishment 13


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V. Conclusions

The collaborative is on track to meet targets ofstrengthened BEmONC skills of providers

Partnership with EMA strengthened midwiferycapacity and enabled efficient rollout of training

Lack of essential equipment remains achallenge

Phone follow-up and support works but someneed on-site visit

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Acknowledgement

Ministry of Health

Regional Health Bureau

UNICEF Ethiopian Midwifery Association

Headquarter experts: Sheena Currie, Maya

Tholandi

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national rollout to strengthen basic emergency obstetric and newborn care in ethiopia. tyigzaw....

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