The FIGO Save the Mothers Initiative: The Ethiopia-Sweden collaboration

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Study Justification:
– The FIGO Save the Mothers Fund aimed to establish basic and comprehensive emergency obstetric care (EmOC) in Ethiopia.
– The specific objectives were to increase the availability and utilization of quality obstetric care, with the goal of reducing maternal deaths.
– The Save the Mothers Project (SMP) was launched in West Showa Zone (WSZ), Ethiopia in 1998 to implement and evaluate the intervention.
Highlights:
– The intervention package included capacity building, training healthcare providers in EmOC.
– Equipment, materials, and supplies were provided to the demonstration sites to enable them to provide EmOC services.
– The interventions led to improvements in availability, utilization, and met need for obstetric care.
– The cesarean section rate at Ambo Hospital increased from 3.7% in 1998 to 17.3% in 2001.
– The total number of deliveries and cases admitted with obstetric complications increased at Ambo Hospital.
– The case fatality rate for direct maternal deaths decreased from 7.2% to 4.6% in 2001.
Recommendations:
– Replicate similar low-cost EmOC projects to attract decision-makers.
– Maintain a favorable political climate and adapt to local conditions for success.
Key Role Players:
– Ethiopian Society of Obstetricians and Gynecologists (ESOG)
– FIGO Save the Mothers Fund
– Ambo Hospital
– Shenen and Ijaji Health Centers
Cost Items for Planning Recommendations:
– Training of staff members
– Provision of equipment and supplies
– Regular supervision
– Maintenance of relative peace and political stability
Please note that the cost items provided are budget items and not actual costs.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The abstract provides specific objectives, intervention details, and outcome measures. It also includes quantitative data showing improvements in availability, utilization, and case fatality rate. However, the abstract lacks information on the study design, sample size, and statistical analysis. To improve the strength of the evidence, the authors could provide more details on the study methodology, including a clear description of the study design, sample size calculation, and statistical analysis plan. Additionally, including information on potential limitations and confounding factors would enhance the credibility of the findings.

The overall goal of the FIGO Save the Mothers Fund was to establish basic and comprehensive emergency obstetric care (EmOC) with the specific objectives of increasing the availability and utilization of quality obstetric care as measured by the UN indicators. As a result of this commitment by FIGO, the Ethiopian Society of Obstetricians and Gynecologists (ESOG) launched the Save the Mothers Project (SMP) in West Showa Zone (WSZ), Ethiopia in 1998 to implement and test a demonstration project and evaluate the feasibility and impact of the intervention. The overall objectives matched FIGO’s – reducing maternal deaths by promoting the availability, access and utilization of EmOC services for women with complications of pregnancy and childbirth. The intervention package included capacity building as a major activity, and physicians and other service providers from Ambo Hospital, Shenen and Ijaji Health Centers were trained in EmOC. This was intended to combat the high staff turnover in the area. Equipment, materials and supplies were also provided to the demonstration sites to enable them provide basic and comprehensive EmOC services. The interventions, begun in 1999, led to improvements in availability, utilization and met need, which suggests that such an approach may eventually lead to the reduction of maternal deaths. The cesarean section rate for Ambo Hospital increased from 3.7% in 1998 to 17.3% in 2001 – an almost six-fold increase. At Ambo Hospital both the total number of deliveries and cases admitted with obstetric complications have increased from baseline. Patients with obstructed labor comprise 39% of all obstetric patients making it the leading cause of hospitalization. Obstetric hemorrhage comes next with 24% of all admissions. The case fatality rate (CFR) (for direct maternal deaths) decreased from 7.2% at baseline, to 4.6% in 2001 – showing a definite trend of improvement. Currently, there is 24-h EmOC service at Ambo Hospital where an obstetrician and general medical practitioners with EmOC training are responsible for the service. Shenen and Ijaji health Centers are upgraded in terms of training of staff members, provision of equipment and supplies, and regular supervision so that the community in these areas has access to basic EmOC services. To replicate similar activities, in a setting like ours, EmOC projects have to be low cost to attract decision-makers. The SMP used almost US $100000 over 3 years to ensure availability of EmOC services for women in WSZ. A favorable political climate such as maintenance of relative peace, and flexibility in adapting to local conditions also contributed to the success of the SMP. © 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.

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Based on the information provided, here are some innovations that could potentially improve access to maternal health:

1. Capacity building: Training physicians and other service providers in emergency obstetric care (EmOC) can help combat high staff turnover and ensure that healthcare facilities have skilled professionals to provide quality care.

2. Provision of equipment and supplies: Providing necessary equipment, materials, and supplies to healthcare facilities can enable them to offer basic and comprehensive EmOC services, improving the availability of care.

3. Upgrading health centers: Upgrading health centers in terms of staff training, equipment, and supplies can ensure that communities have access to basic EmOC services, even in remote areas.

4. 24-hour EmOC service: Establishing round-the-clock EmOC services at hospitals, staffed by obstetricians and general medical practitioners with EmOC training, can ensure that women have access to emergency care at any time.

5. Low-cost EmOC projects: Developing EmOC projects that are cost-effective can attract decision-makers and increase the likelihood of replication in similar settings.

6. Favorable political climate: Maintaining relative peace and having flexibility in adapting to local conditions can contribute to the success of maternal health initiatives, making it easier to implement and sustain improvements in access to care.

Please note that these are potential recommendations based on the information provided, and further research and assessment would be needed to determine their feasibility and effectiveness in specific contexts.
AI Innovations Description
The recommendation to improve access to maternal health based on the FIGO Save the Mothers Initiative in Ethiopia-Sweden collaboration is to establish basic and comprehensive emergency obstetric care (EmOC) services. This includes increasing the availability and utilization of quality obstetric care, as measured by UN indicators. The intervention package should include capacity building activities, such as training physicians and other service providers in EmOC. Additionally, providing equipment, materials, and supplies to healthcare facilities is crucial to enable them to provide basic and comprehensive EmOC services. It is important to combat high staff turnover by investing in training and support. The success of the initiative in Ethiopia was also attributed to a favorable political climate and flexibility in adapting to local conditions. To replicate similar activities in other settings, EmOC projects should be low cost to attract decision-makers.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations for improving access to maternal health:

1. Strengthening capacity building: Continue investing in training programs for healthcare providers, including obstetricians and general medical practitioners, to enhance their skills in emergency obstetric care (EmOC). This will ensure that there are enough skilled professionals available to provide quality maternal healthcare services.

2. Improving infrastructure and equipment: Allocate resources to upgrade healthcare facilities, such as hospitals and health centers, by providing necessary equipment, materials, and supplies for basic and comprehensive EmOC services. This will enable these facilities to handle obstetric complications effectively and efficiently.

3. Enhancing community outreach and education: Implement community-based programs to raise awareness about maternal health, pregnancy complications, and the importance of seeking timely medical care. This can be done through health education campaigns, workshops, and partnerships with local community organizations.

4. Strengthening referral systems: Develop and implement effective referral systems to ensure that pregnant women with complications can access higher-level healthcare facilities when needed. This includes establishing clear communication channels between primary healthcare centers and referral hospitals.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of women receiving EmOC services, the percentage of women receiving timely care, and the reduction in maternal mortality rates.

2. Collect baseline data: Gather data on the current state of maternal health access, including the availability and utilization of EmOC services, maternal mortality rates, and other relevant indicators.

3. Design intervention scenarios: Develop different scenarios based on the recommendations mentioned above. For each scenario, determine the expected changes in capacity building, infrastructure, community outreach, and referral systems.

4. Simulate the impact: Use modeling techniques, such as mathematical modeling or simulation software, to estimate the potential impact of each scenario on the identified indicators. This can involve analyzing the projected increase in the number of women receiving EmOC services, the reduction in maternal mortality rates, and other relevant outcomes.

5. Evaluate and compare scenarios: Assess the results of each scenario simulation and compare the projected impacts. This will help identify the most effective recommendations for improving access to maternal health.

6. Refine and implement the chosen recommendations: Based on the simulation results, refine the recommendations and develop an implementation plan. This plan should include strategies for resource allocation, stakeholder engagement, and monitoring and evaluation to ensure successful implementation and sustained impact.

It is important to note that the methodology described above is a general framework and may require further customization based on the specific context and available data.

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