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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