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Cycle 5 (2016 Deadline)

Improved access and uptake of maternal and child health services in rural Ethiopia through collaborative community and health systems partnership

PI: Getahun Asres Alemie (, University of Gondar
U.S. Partner: Judd Walson, University of Washington
Project dates: December 2016 - December 2018

Project Overview:

In 2015, the average Ethiopian woman had a 1 in 64 lifetime risk of death due to complications of childbirth, and 87,414 newborns died before their 28th day of life. Reducing maternal and neonatal deaths has been at the top of the global health agenda for more than a decade and was recently included in Goal 3 of the Sustainable Development Goals (SDGs). Demand for maternal, newborn, and child health (MNCH) services, however, still remains low in Ethiopia’s rural communities most at risk. Complex challenges, including transportation, health literacy, imbalanced decision-making authority, and harmful traditional practices, create barriers to increasing health coverage.

This implementation science study will utilize an integrated delivery approach to increase demand for MNCH services in the Gondar region of Ethiopia. The research design aims to address primary drivers of maternal and neonatal death, including access to antenatal care, prevention of mother-to-child transmission of HIV (PMTCT), facility-based delivery, and postpartum visits through a culturally driven lens. The goal of the project is to improve MNCH outcomes in rural Ethiopia by increasing demand for services through the linkage of local health workers and community influencers. The study team will collect and analyze qualitative data to establish a baseline for women’s engagement with their health facilities, identify barriers to accessing MNCH services, and parse out traditional practices and beliefs around childbirth and infant health, including religious rituals. From the baseline information, a behavior change intervention will be implemented in which community leaders from the Ethiopian Orthodox Church will be paired with members of the Health Development Army (HDA) and trained to conduct maternal and child health outreach and education. Strategies for transporting laboring and postpartum women to health facilities will be devised and implemented by the local communities. The study team will develop a clear monitoring and evaluation plan at the outset of the study, including tracking time to seeking care, frequency of seeking care, removal of barriers to care, and measures of morbidity and mortality. The study hypothesis is that there will be an increase in demand for MNCH services following the intervention, with targeted increases in the uptake of antenatal care, PMTCT, facility-based delivery, and postnatal care and referral. It is expected that the impact of increased engagement with health facilities will decrease maternal and neonatal deaths in the study population compared to the control group.

Summary of Recent Activities: 

After the priest and Health Development Army (HDA) training was done in the last phase of the second quarter of the second year, priests and HDAs were dispatched to their respective communities to do their field work. The main activities done during the third quarter of 2018 were supervision visits of the field work performed by priests and HDAs in the intervention areas (catchment areas of six health centers) and data extraction visits of the health centers both in the intervention (six health centers) and the control areas (twelve health centers). The supervision visits were done roughly every month whereas the health center data extraction visits were done roughly every two months. The supervision visits involved follow-up group discussions with priests, HDAs, and health center staff. The discussions included reports of activities done by priests and HDAs, number of pregnant women they educated and referred to health centers for antenatal care (ANC) and facility delivery, challenges encountered, possible solutions, etc. Reports of the discussions were regularly reported to the study team at the University of Gondar (UoG) and collaborators at the University of Washington (UW). During the data extraction visits, UoG team traveled to the eighteen health centers to collect health facility data for the twelve months preceding the FLAME (Faith Leaders Advocating for Maternal Empowerment) intervention and the months since the start month of the intervention. The collected data included monthly figures of ANC visits, health facility deliveries, maternal and child deaths, and immunizations.

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