Emory Nursing Maternal and Neonatal Health in Ethiopia Partnership

Approach

trainingA basic package of interventions can help improve maternal and newborn survival rates by more than one-third if delivered during the critical period from birth to the first 48 hours of life. These interventions are largely preventive and inexpensive, and can be provided by both frontline health workers and family members.

For the mother, the package of care consists of:

  • Care at delivery: clean delivery; administration of drugs, such as misoprostol, that cause the uterus to contract and reduce blood loss after delivery; and uterine massage
  • Postpartum health assessment: breast check, bleeding check, trauma check (fistula), and fever check
  • Counseling: breast care, nutrition (esp. fluids), personal hygiene, rest, uterine massage, illness recognition and care seeking

For the newborn, the package of care consists of: 

  • Thermal protection
  • Clean cord care
  • Resuscitation, if needed
  • Postnatal health assessment: color check, activity check, feeding check
  • Counseling of mother for: promotion of immediate, exclusive breastfeeding, thermal care, kangaroo mother care for preterm/small babies, hand-washing, clean cord care, illness recognition and care seeking

MaNHEP is working to provide more women and newborns with this basic package of interventions. Much of this effort focuses on strengthening the capacity of Ethiopia's Health Extension Program to provide high-quality, continuous, and equitable maternal and newborn health (MNH) care and supporting frontline health worker teams comprised of health extensions workers (HEWs), volunteer community health workers, traditional birth attendants, and family caregivers.

MaNHEP is working in six rural woredas or districts of Ethiopia with high rates of maternal and newborn mortality. Key components of the project include:

  • Improving the capability and performance of frontline health workers. MaNHEP has designed an innovative Community-based Maternal and Newborn Health Training (CMNH) program for frontline health workers focused on improving clinical skills of MNH care. The program is built around a ‘training of trainers' cascade approach designed to promote a sustainable capacity-building process. An initial group of health extension worker supervisors, nurse midwives, and maternal-newborn health specialists are trained in the MNH package of care. These individuals then share their knowledge with other frontline health workers, all the way to the community level. Community and family members who attend home births also receive training in clean and safe delivery practices, as well as how to identify complications that require skilled care.

    The CMNH process builds on local knowledge and skills through discussions, demonstrations, negotiations, and practice, with the goals of gaining acceptance by the participants and increasing the likelihood that the skills and knowledge will be used. The process is empowering and creates bonds among program facilitators, women, and families. Strong relationships among these groups will be central to promoting greater acceptance of MNH practices by women and their families and ensuring that they receive postnatal care and counseling within 48 hours of birth by HEWs. Trainers use culturally appropriate visuals to teach concepts which are brought to life through hands-on simulations. The Take Action Card Booklet for frontline health workers can be reviewed here.
  • Increasing demand for MNH services and promoting behaviors in pregnant mothers that increase newborn survival rates. MaNHEP employs behavior change communications to change attitudes and behaviors towards MNH care. Community mobilization activities are also being undertaken to build the knowledge and skills of pregnant women and family members about practices that can increase survival rates in the early postnatal period. In addition, frontline health workers are working with communities to develop systems for identifying pregnant women, notifying health workers of pregnancies and imminent deliveries, and transporting women to health facilities (when indicated and where possible).
  • Demonstrating a ‘lead woreda' approach to improving MNH practices and services. MaNHEP is applying an established quality improvement model to strengthen health systems in the six woredas. The initial focus of quality improvement activities is to strengthen pregnancy and birth notification systems, essential components of strong maternal and newborn health care systems. Lead woredas will focus on how to support communities as they continuously improve the care that they are providing and develop practical solutions to overcome challenges of delivering MNH care. As advocates and technical resources to other districts, lead woredas are expected to eventually guide improvements to MNH care throughout Ethiopia.

An estimated 19,000 women and their families are expected to benefit from MaNHEP activities over the duration of the project. MaNHEP's activities are aligned with the priorities of the Federal Ministry of Health in Ethiopia to improve maternal and newborn health and survival rates.

More about MaNHEP activities may be found here.

Photo caption: Health extension workers take part in the Community-based Maternal and Newborn Health Training Program.