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Many communities all over the world struggle to stop the deaths of women and babies. Teams making progress - despite big challenges - have important lessons to share.
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Persistence and Creativity: The Keys to Improving Maternal and Newborn Health

By IHI Multimedia Team | Wednesday, May 23, 2018
IHI Ethiopia Team

Childbirth should be the happiest day of a mother’s life. However, providers struggle in too many communities worldwide to stop the deaths of women and babies. To improve maternal and newborn health, providers with limited resources — wherever they are in the world — can learn from IHI’s team in Ethiopia because they’ve made notable progress by using quality improvement (QI) skills, creativity, and persistence in the face of great challenges. IHI Senior Project Officers Befikadu Bitewulign, Mehiret Abate, and Haregeweyni Alemu share some examples of this below.

Compared to the country’s improvements in child mortality, maternal and neonatal mortality rates (MMR and NMR) in Ethiopia remain persistently high. (Ethiopia reduced child deaths by more than two-thirds over the past 20 years.) Since October 2013, IHI has worked in partnership with the Ethiopian Federal Ministry of Health (FMoH), with the support of the Bill & Melinda Gates Foundation and Margaret A. Cargill Philanthropies, to explore how QI methodologies might accelerate efforts to reduce mortality among mothers and newborns.

In support of the government’s ambitious agenda, IHI provides clinical training, mentorship, medical equipment support, and on-site coaching of nurses and midwives to improve the quality of care provided to mothers and infants in vulnerable communities across the country.

IHI’s 12 Senior Project Officers (SPOs) in Ethiopia are based in five of the 11 regions of the country, providing QI support and clinical coaching to district staff, facility heads, health providers, and community leaders at hospitals and health centers in the districts in which IHI’s improvement collaboratives operate. Three SPOs describe below how their work is improving the lives of families in their regions.

IHI Senior Project Officer Befikadu Bitewulign (Oromia Region)

The predominant causes of neonatal mortality in Ethiopia include sepsis, birth asphyxia, and complications related to premature birth. Until recently, newborns received little programmatic attention from the health system, as evidenced by the absence of Neonatal Intensive Care Units (NICUs) in all primary hospitals in our collaboratives.

In the Lemu Bilbilu district, 60 percent of under-five child death is attributed to neonatal death. Following our initial assessment of the district hospital, the IHI staff in Ethiopia worked with their CEO to establish a NICU unit. We also provided a modified NICU training for nurses and physicians to run the unit, and encouraged them to mobilize a local resource to set up the unit. We have also helped launch a dedicated NICU quality improvement team that includes delivery staff, nurses, the CEO, medical director, and physicians to design projects to address newborn mortality. Within six months, the unit admitted 124 neonates and demonstrated a 95 percent survival rate from birth to discharge time.

IHI Senior Project Officer Mehiret Abate (Southern Nations, Nationalities, and People’s Regions)

 Mehiret Abate coaches another nurseMehiret Abate coaches another nurse on how to resuscitate a baby immediately after birth.

The delay in mothers reaching health facilities due to long distances to health centers and lack of available transportation are the main barriers that prevent mothers from receiving appropriate health care in many parts of the world. To combat this, hospitals and health centers in numerous low-resource settings, including Ethiopia, have built maternal waiting areas for mothers at term pregnancy (roughly 40 weeks) where they can stay until their time to deliver.

Maternal waiting areas help to increase skilled delivery and aid in early identification and management of birth complications. Health facilities in the Duguna Fango district did not have maternal waiting areas and saw low facility delivery rates as a result.

After IHI held its first collaborative learning session, the Duguna Fango district health office took on the establishment of a maternal waiting area as an improvement project. They created the maternal waiting area at the Bitena Hospital for expectant mothers to receive food, make them more comfortable, and hear lessons on health education to prepare for their new babies. More than 420 mothers have been admitted to the maternal waiting area since it was established in November 2016. One mother said, “Myself and my baby will be in good hands, and I prefer to give birth in the facility. I will tell the community that coming to the maternity waiting area is not strange thing.”

 A group of women in the maternal waiting area.

A group of women in the maternal waiting area at the Bitena Hospital in Duguna Fango district, Ethiopia.

IHI Senior Project Officer Haregeweyni Alemu (Tigray Region)

Syphilis is devastating to mothers and infants if untreated, and simple and easy to cure if detected. This is why it’s a regular part of maternity care in many countries. Syphilis testing was not happening reliably at many facilities in Ethiopia, however, because there aren’t enough lab technicians who have the training to do the test. To address this shortage in Tanqua Abergele district, IHI trained nurses who were interested and able to incorporate the task into their routine antenatal care.

Some may not see shifting the testing onto nurses as an improvement. In this context, however, this streamlines care for the patient, builds skills of a health care worker, and overcomes a system constraint. The result of this change was a major increase in the rate of syphilis testing during pregnancy even when a facility has no lab technician.

 A lab technician trains midwivesA lab technician trains midwives to do basic tests.

As many health systems working to achieve the Triple Aim have learned, you need to understand and work with communities to make real and sustainable change. To do this, most of IHI’s over 25 full-time staff in Ethiopia will continue to spend time away from the IHI office in Addis Ababa to provide trainings, coaching visits, and learning sessions in support of maternal and neonatal health improvement collaboratives around the country.

You may also be interested in:

Using Improvement Science to Address Maternal Mortality in the US 

Designing a Population Approach to Maternal Health and Care

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