Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia

  • Tropical Medicine and International Health, Volume 22, No. 2, Year 2017

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Study Justification:
This study aims to identify the factors that hinder or enable strategies to reduce delays in maternal health services in rural and pastoralist areas of Ethiopia. By understanding these factors, policymakers and stakeholders can develop targeted interventions to improve access to maternal health services and reduce maternal mortality rates in these regions.
Study Highlights:
– The study conducted a key informant study with 44 Health Extension Workers in three different regions of Ethiopia.
– Factors related to reducing the first delay, such as home birth traditions, decision-making, distance, and lack of transport, were found to be consistent across all three locations.
– Factors related to reducing the second delay differed significantly. In Adwa Woreda, Health Extension Workers were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they require Emergency Obstetric and Newborn Care.
– Initiatives to reduce delays can be effective in improving access to maternal health services, particularly when Health Extension Workers are supported by the Health Development Army and a functioning referral system.
– District health offices should ensure that ambulances are used as intended to facilitate timely access to emergency obstetric care.
Recommendations for Lay Reader and Policy Maker:
1. Strengthen the support provided to Health Extension Workers in rural and pastoralist areas to improve their capacity to refer women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care.
2. Develop and implement targeted interventions to address the factors contributing to the first delay, such as home birth traditions, decision-making, distance, and lack of transport.
3. Address the variations in the second delay by ensuring that Health Extension Workers have the necessary resources and support to call ambulances when needed.
4. Promote the role of the Health Development Army in supporting Health Extension Workers and improving maternal health outcomes in rural and pastoralist areas.
5. Enhance coordination and communication between district health offices and Health Extension Workers to ensure that ambulances are used appropriately and efficiently.
Key Role Players:
– Ministry of Health, Ethiopia
– District Health Offices
– Health Extension Workers
– Health Development Army
– Traditional Birth Attendants
– Community leaders and elders
– Non-governmental organizations (NGOs) working in maternal health
Cost Items for Planning Recommendations:
– Training programs for Health Extension Workers
– Provision of necessary equipment and supplies for Health Extension Workers
– Awareness campaigns and community education initiatives
– Strengthening referral systems and ambulance services
– Monitoring and evaluation activities to assess the impact of interventions
– Support for the Health Development Army’s involvement in maternal health initiatives
– Collaboration with NGOs and other stakeholders for resource mobilization and implementation of interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a key informant study with 44 Health Extension Workers in three different regions of Ethiopia. Thematic analysis was used to analyze the data. The study found that factors related to reducing the first delay did not differ between the locations, but factors related to reducing the second delay differed substantially. Health Extension Workers in one region were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In another region, some Health Extension Workers were discouraged from calling ambulances. In the third region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants. The study provides valuable insights into the factors that hinder or enable maternal health strategies in rural and pastoralist areas in Ethiopia. To improve the strength of the evidence, future studies could consider a larger sample size and include a wider range of regions in Ethiopia.

Objectives: To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia. Methods: A key informant study was conducted with 44 Health Extension Workers in Afar Region, Kafa Zone (Southern Nation, Nationalities and Peoples’ Region), and Adwa Woreda (Tigray Region). Health Extension Workers were trained to interview women and ask for stories about their recent experiences of birth. We interviewed the Health Extension Workers about their experiences referring women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care. Data were analysed using thematic analysis. Results: Themes related to reducing the first delay, such as the tradition of home birth, decision-making, distance and unavailability of transport, did not differ between the three locations. Themes related to reducing the second delay differed substantially. Health Extension Workers in Adwa Woreda were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances as they were used for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they need to travel to health facilities for Emergency Obstetric and Newborn Care. Conclusions: Initiatives to reduce delays can improve access to maternal health services, especially when Health Extension Workers are supported by the Health Development Army and a functioning referral system, but district (woreda) health offices should ensure that ambulances are used as intended.

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Based on the research findings, here are some innovations that can be developed to improve access to maternal health:

1. Strengthening the Health Development Army: This community-based approach can be expanded to other regions to ensure adequate support for maternal health services. This can involve training and empowering community members to assist Health Extension Workers in calling ambulances when needed.

2. Enhancing the referral system: Innovations can be implemented to improve the efficiency and effectiveness of the referral system. This can include the use of technology, such as mobile applications or telemedicine, to facilitate prompt and accurate referrals to appropriate healthcare facilities.

3. Addressing cultural norms and practices: Innovations can focus on raising awareness and providing education to address cultural beliefs and practices that discourage women from seeking skilled birth attendance. This can involve community engagement programs, involving traditional birth attendants in the healthcare system, and promoting the benefits of skilled care during childbirth.

4. Improving transportation availability: Innovations can focus on improving transportation infrastructure and availability in rural and pastoralist areas. This can include initiatives such as mobile health clinics, transportation vouchers, or partnerships with local transportation providers to ensure that women can easily access healthcare facilities when needed.

By implementing these innovations, access to maternal health services can be improved, reducing delays and ultimately improving maternal and newborn health outcomes in rural and pastoralist areas in Ethiopia.
AI Innovations Description
Based on the research findings, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening the Health Development Army: The Health Development Army played a crucial role in enabling Health Extension Workers in Adwa Woreda to call ambulances when needed. This community-based approach can be further developed and expanded to other regions to ensure that there is adequate support for maternal health services.

2. Enhancing the referral system: A functioning referral system was found to be effective in reducing the second delay in accessing maternal health services. Innovations can be implemented to improve the efficiency and effectiveness of the referral system, ensuring that women are promptly referred to appropriate healthcare facilities when needed.

3. Addressing cultural norms and practices: The tradition of home birth was identified as a factor hindering access to maternal health services. Innovations can focus on raising awareness, providing education, and addressing cultural beliefs and practices that discourage women from seeking skilled birth attendance. This can be done through community engagement programs, involving traditional birth attendants, and promoting the benefits of skilled care during childbirth.

4. Improving transportation availability: Distance and unavailability of transport were identified as barriers to accessing maternal health services. Innovations can focus on improving transportation infrastructure and availability in rural and pastoralist areas, ensuring that women can easily access healthcare facilities when needed. This can include initiatives such as mobile health clinics, transportation vouchers, or partnerships with local transportation providers.

By implementing these recommendations as innovative solutions, access to maternal health services can be improved, reducing delays and ultimately improving maternal and newborn health outcomes in rural and pastoralist areas in Ethiopia.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Selection of study sites: Choose rural and pastoralist areas in Ethiopia where access to maternal health services is known to be limited. These areas should represent a range of geographical, cultural, and socioeconomic contexts.

2. Baseline data collection: Conduct a survey or interviews with women in the selected study sites to gather information on their experiences and challenges in accessing maternal health services. Collect data on factors such as home birth practices, transportation availability, referral system effectiveness, and community support.

3. Intervention implementation: Implement the recommended innovations in the selected study sites. Strengthen the Health Development Army, enhance the referral system, address cultural norms and practices, and improve transportation availability. Ensure that these interventions are tailored to the specific needs and context of each study site.

4. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on key indicators related to access to maternal health services. This can include the number of women referred for skilled birth attendance, the time taken for referrals, the number of women opting for facility-based births, and the availability and utilization of transportation services.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health services. Compare the baseline data with the post-intervention data to identify any changes or improvements. Use statistical methods to determine the significance of the findings.

6. Reporting and dissemination: Prepare a comprehensive report summarizing the findings of the study, including the impact of the recommended innovations on access to maternal health services. Disseminate the findings to relevant stakeholders, such as policymakers, healthcare providers, and community members, to inform future decision-making and program planning.

By following this methodology, researchers can simulate the impact of the recommended innovations on improving access to maternal health services in rural and pastoralist areas in Ethiopia. The findings can provide valuable insights for designing and implementing effective interventions to address the identified barriers and improve maternal and newborn health outcomes.

Statistics:
Citations: 29
Authors: 4
Identifiers:
DOI: 10.1111/tmi.12818
ISSN: 13602276
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Ethiopia
Study Approach:
Qualitative
Participants Gender:
Female
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