1. UNIVERSITÉ LIBRE DE BRUXELLES
SCHOOL OF PUBLIC HEALTH
MC in public health methodology
program
O p e r a t io n a l r e s e a r c h a n d
p la n n in g
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)
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April, 2012
2. Presentation outline
3 Needs-offer-demands frame
3 Unsatisfactory issue and intervention(Managerial
blocks)
3 Goal, objective and results
3 Indicators
3 Main activities
3 Gantt Chart
3 Team: persons involved
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3. Needs-offer-demands frame
•Rural women had low
demand and utilization
of institutional delivery
Low demand
There is need
Low offer
•low access and poor
quality skilled delivery
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4. 1. Unsatisfactory issue and intervention
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 referral
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5. Managerial blocks
Next
slides
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6. Managerial blocks
1. 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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7. 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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8. 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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9. 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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10. 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.
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11. 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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12. 2. Goal, objective and results
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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13. Goal
3. Indicators
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 intervention
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17. 6. Team: persons involved
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
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hospitals.
18. 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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