key findings from reachout work in ethiopia

Opportunities and challenges to embedding quality improvement into the Ethiopian health system

Daniel G. Datiko, MD, PhD REACH ETHIOPIA June 12, 2016, BRAC, Bangladesh

Ethiopia - maternal health 4th highest maternal mortality: 676 /105

LBLow institutional delivery High attrition from 1st to 4th ANC attendance

Background

• Launched Health Extension Programme in 2004

• Recruited female Health Extension Workers

• Improve access to primary healthcare

• Provide curative, preventive and promotive health services

Background

• Baseline context analysis was carried out to identify barriers and facilitators for Health Extension Workers’ performance on maternal health Focus - improving the quality of Antenatal Care provided by the Health Extension Workers and linking mothers to facility delivery

Baseline

• Quality improvement intervention

• Improve community engagement

• Pregnant Women’s Forum and Health Development Army leaders

• Strengthen supportive supervision

• Improve referral linkages

Intervention

• Capacity building: Health Extension Workers and supervisors

• Provided guides: Pregnant Women’s Forum, Health Development Army and supervision

• Developing supervision checklist and referral slips

• Facilitated implementation in the community

Main activities

Monthly performance report ፡ HP, HC and WoHOQuarterly data collection Joint supportive supervisionPerformance review meeting

Monitoring and Evaluation

• Improved Health Extension Workers’ knowledge and skill about Antenatal Care

• Increased checklist supported supervision • Increased attendance of mothers in Pregnant

Women’s Forum • Improved use of guides, registers and referral• Improved service utilization: referral uptake and

skilled delivery

Key results

The trend of pregnant women identification by Health Development Army

• Maternal health is top priority and commitmentAvailability of Health Extension Programme policy, guidelines and standards

• Organization of Primary Health Care Unit: Health Development Army, Health Extension Workers and supervisors

• Long standing partnership and stakeholders engagement

Opportunities

• High turn over of Health Extension Worker supervisors

• Motivation of the Health Extension Workers and the Health Development Army

• Inadequate logistics and basic facilities • Limited experience about QI interventions

Competing priorities

Challenges