When maternal and newborn death rates are high — 37 mothers and 75 newborns in one hospital, in one year—what do you do to change that?
While strengthening health infrastructure and systems is an important step, building the capacity of health workers is a vital and complementary intervention.
In 2011, Ethiopia’s maternal mortality ratio was high—676 deaths per 100,000 live births—and only 10 percent of those births were presided over by skilled birth attendants, according to the Ethiopia Demographic and Health Survey (EDHS).
Dessie Referral Hospital sits in Ethiopia’s Amhara Region, an area of the country made famous by the Blue Nile that flows out of Lake Tana—one of two primary sources of the famed river. It’s a slightly larger area than the state of New York, and the hospital serves an estimated 3.5 million people.
“There used to be a lot of complaints by the community as the services did not meet the needs of the people who sought the maternal and newborn health services being delivered in the facility,” said Seid Tesfaw, the Chief Executive Officer of the hospital.
Indeed, Dessie Referral Hospital’s maternal and newborn mortality rates were well above the national average.
So in 2012, Jhpiego, with funding from UNICEF and support from the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program, initiated a skills-strengthening training and quality improvement effort to enhance the care that mothers and newborns would receive at the hospital.
Improving the Quality of Maternal and Newborn Services
Jhpiego partnered with the hospital to establish a fully equipped basic emergency obstetric and newborn care training site on the hospital grounds. There, midwives, nurses, doctors and students have received standardized clinical training in basic, essential and emergency care for mothers and their babies.
The training focuses on ensuring that health care workers are competent in delivering safe maternal and newborn care. Jhpiego’s support also introduced a quality improvement approach that implemented standards of quality care.
In a hospital with some 400 staff members, including midwives, obstetricians and emergency surgical officers, the training had an enormous impact.
By the end of 2013, less than two full years into the Jhpiego-led maternal and newborn skills strengthening program, the hospital had recorded just one maternal death, down from 37 the previous year.
Today, according to Tesfaw, Dessie Referral Hospital has become the top choice for maternal care among Ethiopians in the area. Its quality of services has improved dramatically, and its staff is equipped to manage everything from basic care—like active management of the third stage of labor—to emergency services arising from complications such as postpartum hemorrhage, pre-eclampisa/eclampsia and newborn asphyxia.
“Working for the women is working for the entire family,” says Tesfaw. “Thanks to Jhpiego’s support, the health care providers are competent and confident, and the quality of service at the facility has improved.”