Ethiopia’s assessment of emergency obstetric and newborn care: Setting the gold standard for national facility-based assessments

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Study Justification:
– The study aimed to assess emergency obstetric and newborn care services in Ethiopia.
– It sought to provide a comprehensive understanding of the current state of these services.
– The study aimed to identify areas for improvement and inform national and subnational planning efforts.
– It aimed to contribute to the development of best practices and guidelines for similar assessments in other countries.
Highlights:
– The study was conducted by a team of maternal and newborn health experts from various organizations.
– 806 public and private facilities were included in the assessment.
– Results were published in national and regional reports, as well as in journal articles.
– The assessment informed improvements in water infrastructure and access to magnesium sulfate.
– It established a permanent database for future monitoring of the health system.
Recommendations:
– Strengthen local leadership and collaboration in the assessment and planning processes.
– Provide ample financial and technical support for future assessments and improvements.
– Continuously monitor and evaluate the health system, using the established database.
– Disseminate best practices and guidelines to other countries conducting similar assessments.
Key Role Players:
– Federal Ministry of Health (FMOH)
– United Nations Children’s Fund (UNICEF)
– World Health Organization (WHO)
– United Nations Population Fund (UNFPA)
– Ethiopian Society of Obstetricians and Gynecologists
– Columbia University’s Averting Maternal Death and Disability Program
Cost Items for Planning Recommendations:
– Funding for data collection, analysis, and reporting
– Technical assistance from experts and organizations
– Training and capacity-building for data collectors
– Management of field work and data by a private firm
– Development and maintenance of the permanent database
– Dissemination of assessment results and guidelines

Objective: To describe the methods used to implement Ethiopia’s 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. Methods: A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University’s Averting Maternal Death and Disability Program provided technical assistance. Results: Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. Conclusion: Ethiopia’s assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning. © 2011 Elsevier Ireland Ltd.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Collaborative assessment process: Implement a collaborative process involving experts from various organizations and stakeholders to assess the emergency obstetric and newborn care services in a country. This can help identify gaps and areas for improvement.

2. Data collection modules: Develop standardized data collection modules that can be used by trained data collectors to gather information from public and private facilities. This can ensure consistent and reliable data collection.

3. Data quality management: Implement a multi-layered plan for data quality management, involving both the core team and a private firm. This can help ensure the accuracy and reliability of the collected data.

4. Facility factsheets: Create facility factsheets that provide concise information about each facility, including its capabilities and services offered. These factsheets can be used for subnational planning activities and help improve access to maternal health services.

5. Integration of assessment results: Rapidly integrate the assessment results into national and subnational planning activities. This can help inform decision-making and prioritize interventions to improve maternal health.

6. Permanent database: Establish a permanent database to monitor the health system, including the geographic locations of surveyed facilities. This can facilitate ongoing monitoring and evaluation of maternal health services.

7. Technical assistance: Provide technical assistance from organizations with expertise in maternal and newborn health, such as Columbia University’s Averting Maternal Death and Disability Program. This can support the implementation of best practices and guidelines for conducting similar assessments in other countries.

These innovations, as demonstrated in Ethiopia’s assessment, can contribute to improving access to maternal health services and inform evidence-based decision-making.
AI Innovations Description
The recommendation from the study is to conduct facility-based assessments of emergency obstetric and newborn care services (EmONC) in order to improve access to maternal health. The study in Ethiopia demonstrated the effectiveness of this approach in informing national and subnational planning and improving maternal health outcomes.

The key steps involved in implementing this recommendation are as follows:

1. Collaborative Process: Engage a team of maternal and newborn health experts, along with representatives from relevant organizations and professional societies, to provide technical guidance and support throughout the assessment process.

2. Data Collection: Train data collectors to administer standardized data collection modules in public and private healthcare facilities. Collect data on various aspects of emergency obstetric and newborn care services, including infrastructure, availability of essential supplies and medications, and healthcare provider skills.

3. Data Quality Assurance: Develop a multi-layered plan for ensuring data quality, including regular supervision and monitoring of data collectors, data validation procedures, and data cleaning and analysis.

4. Dissemination of Results: Publish assessment results in national and regional reports, as well as in facility factsheets. Make the findings accessible to policymakers, healthcare providers, and other stakeholders involved in maternal health planning and implementation.

5. Integration into Planning: Use the assessment results to inform and guide national and subnational planning activities. Identify areas for improvement, such as water infrastructure, access to essential medications, and healthcare workforce capacity. Develop strategies and interventions to address these gaps and improve access to maternal health services.

6. Establish a Database: Create a permanent database to store the assessment data and monitor the health system over time. This database can help track progress, identify trends, and inform future planning and decision-making.

It is important to note that the success of this approach relies on active local leadership, collaboration among stakeholders, and adequate financial and technical support. By following these recommendations, other countries can conduct similar assessments and improve access to maternal health services.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening Health Infrastructure: Invest in improving the physical infrastructure of healthcare facilities, including the availability of clean water, electricity, and essential medical equipment.

2. Enhancing Emergency Obstetric and Newborn Care (EmONC) Services: Focus on training healthcare providers in emergency obstetric and newborn care to ensure timely and effective interventions during childbirth complications.

3. Increasing Access to Medications: Improve the availability and accessibility of essential medications, such as magnesium sulfate, which is used to prevent and treat eclampsia, a life-threatening condition during pregnancy.

4. Promoting Community-Based Maternal Health Programs: Implement community-based programs that provide education, support, and access to maternal health services, particularly in remote or underserved areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data Collection: Gather baseline data on the current state of maternal health access, including the number of healthcare facilities, availability of essential services, and maternal health indicators.

2. Define Indicators: Identify specific indicators to measure the impact of the recommendations, such as the number of healthcare facilities with improved infrastructure, the percentage of healthcare providers trained in EmONC, or the increase in the availability of essential medications.

3. Establish a Simulation Model: Develop a simulation model that incorporates the baseline data and the potential impact of each recommendation. This model should consider factors such as population demographics, geographical distribution, and existing healthcare infrastructure.

4. Input Scenarios: Input different scenarios into the simulation model, representing the implementation of each recommendation. For example, simulate the impact of improving infrastructure in 50% of healthcare facilities or training 80% of healthcare providers in EmONC.

5. Analyze Results: Analyze the simulation results to assess the potential impact of each recommendation on improving access to maternal health. This could include measuring changes in maternal health indicators, estimating the number of additional women who can access quality care, or evaluating the cost-effectiveness of each recommendation.

6. Refine and Iterate: Based on the simulation results, refine the recommendations and simulation model as needed. Iterate the process to explore different scenarios and optimize the strategies for improving access to maternal health.

By using this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations and make informed decisions to improve access to maternal health in Ethiopia.

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