Strenghtening Emergency Obstetric Care

Maternal mortality and disability rate in Ethiopia is among the highest in Sub-Saharan Africa. The maternal mortality rate in Ethiopia is 671/100,000 live births (DHS 2005).

Women have limited access to health services, the health system is inadequate to provide emergency obstetrics care, and the referral system is mostly non-functional to avail care for mothers and newborns whenever complications of pregnancy and child-birth arise.

Under utilization of the already existing public facilities by the rural majority makes the matter even worse.

Partnership among agencies and goverment

The Ministry of Health of the Federal Democratic Republic Government of Ethiopia in collaboration with WHO, UNFPA, UNICEF, and World Bank has been implementing the Minimum Package Service (MPS) Initiative since 2001. It focuses on two key areas:

1. Proving care for obstetric emergencies both at the hospital and/ or health center level, and
2. Increasing access to skilled attendance during delivery.

For an effective utilization of the limited resources and bring about a rapid and clear impact the MPS strategy implementation follows a systematic- focused area based approach. Currently the MPS implementation covered 50 health facilities in 10 zones of six regions. This number is expected to rapidly scale up to address the national demand. However, the success depends on a common effort of the government and donor agencies operating in the area of maternal and newborn health. The financial assistance from development agencies such as Swedish International Development Agency (SIDA) has been quiet significant for the up-scaling.

The set objectives of the MPS initiative include;

1. Supporting for strengthening the health system to provide improved maternal care
2. Availing essential services (Emergency Obstetric Care) through functional referral system
3. Improving access and utilization of services through community supported action

Overview of Achievements

Since the time of the MPS implementation various activities were undertaken both during the preparatory and implementation phases. The Preparatory phase comprised of the placement of trained manpower as a team, identifying the gaps in the availability of the basic essential medical equipments and supplies and filling in the gaps , establishing/strengthening referral services and blood transfusion services and last but not the least orienting and mobilizing the community to enhance service utilization as well as resource mobilization. Provision of high impact maternal mortality reduction interventions with proper follow up of quality of care to improve service utilization were the corner stones for the proper implementation of the initiative.

During the 2004 program implementation emphasis was given to strengthening the pilot areas by increasing the coverage to the health facilities that are not yet equipped. Accordingly the resources were mobilized both from the WHO sources. Moreover other resources were also mobilized from partners such as UNICEF and UNFPA for the same purpose including equipping zonal hospitals with facilities for hospital based blood transfusion services.

In-service training of health professionals in both basic and comprehensive training continues for general practitioners, health officers, midwives and nurses was also one of the priority activities this year in order to sustain the essential obstetric services and address the acute shortage of skilled manpower attributed by high staff turnovers.

The MPS implementing regions received technical and financial assistance based on the joint planning conducted in 2003 which focused on consolidation and expansion of the availability of skilled care and emergency obstetrics care for the reduction of maternal and neonatal mortality and disability. Refresher courses on MPS are provided to community level health workers and community leaders; advocacy work is carried out. Equipment and supplies including a set for blood transfusion have been procured; three ambulances procured have been delivered to the MOH for the MPS sites. Measures are also being taken for the procurement of communication radio for referral services.

Thus, most of the activities so far were provision of basic equipments and training of health professionals in the provision of basic essential/emergency obstetric services. There were also activities in the area of strengthening partnership with relevant stakeholders, advocacy works, and mobilization of the community to enhance service utilization and active participation in the initiative.