Emory Nursing Maternal and Neonatal Health in Ethiopia Partnership

About MaNHEP


Each year in Ethiopia, an estimated 22,000 women die from causes related to childbirth. Newborn mortality is also high, with an estimated 100,000 deaths annually. Most of these deaths occur at home, due to lack of basic health care. The Ethiopian Health Sector Development Plan, and its key strategy the Health Extension Program, are focused on improving maternal and newborn survival. In the past five years, Health Extension Workers and health posts have been installed in rural areas to help reach goals for improved maternal and newborn survival. Yet, an opportunity exists to collaborate with the Ministry of Health to further strengthen the Health Extension Program in meeting the needs of mothers and newborns during the time when they are most vulnerable.

The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) began in 2010 as a two-and-a-half year project funded by the Bill & Melinda Gates Foundation. It is now funded by the Micronutrient Initiative and will continue for an additional four years.

MaNHEP has worked in three rural districts Amhara and three districts in Oromia Regions to demonstrate a community-oriented model for improving maternal and newborn health care and to prepare for use nationwide. With the assistance of the Micronutrient Initiative, MaNHEP will extend to the Afar region and focus on improving maternal nutrition. Under the leadership of the Ministry of Health, the initiative is based at Emory University's Nell Hodgson Woodruff School of Nursing and affiliated with the Lillian Carter Center for Global Health & Social Responsibility. Partners include John Snow Research and Training Inc., University Research Co. LLC, Addis Ababa University and Bahir Dar University in Ethiopia. The initiative includes a package of proven home-based care practices that can help to prevent maternal and newborn death and disability, such as clean delivery and essential care in the immediate and early postnatal period. Health extension and other frontline health workers, such as community health volunteers and traditional birth attendants, implement the package with women and their families. The approach is designed to respect and build on local knowledge and skills through discussions, demonstrations, negotiations and practice. Together, frontline health workers work towards safe practices that are culturally acceptable and likely to be used when needed.

To ensure the package of care reaches all women and newborns, in time, every time, the initiative incorporates a quality improvement approach that helps frontline workers and community members learn to identify barriers that may prevent women and newborns from obtaining care. Once identified, communities develop and assess possible solutions to these challenges. Examples of barriers to care include difficulties identifying women who are pregnant, learning when pregnant women begin labor and give birth, ensuring reliable supplies of life-saving medications, and securing transportation to reach health facilities in emergencies. Frontline workers and community members meet regularly to share lessons and successful solutions to overcoming such barriers.

The initiative also aims to improve abilities of district health system managers at each level--hospital, health center, health post--to advocate for, work with, and support frontline workers. A successful community-oriented model is a district health system that is capable of and committed to addressing the needs of childbearing women and their families, and has abilities to find and share solutions, creating environments for frontline workers to meet these needs. More broadly, this district health system will be able to tackle other critical challenges in health service delivery.

Photo caption: A MaNHEP quality improvement advisor reviews information on recent pregnancies with a quality improvement team in North Shoa.