Respectful Care in Ethiopia – The MCHIP Experience

MCHIP/ZIMBABWE

Hannah Gibson, Country Director/MCHIP Project, Ethiopia

Presentation Overview

Country Background The Problem – Why are women not going to

facilities? Program response to integrating women friendly

care in the context of Ethiopia Measuring respectful maternity care Results Opportunities

Country Background

Population: 87 million (PRB, 2012)

84% live in rural areas; agriculture accounts for 54% of GDP

80 spoken languages Health System organization:

Primary Health Care Units = 1 health center with 4-5 health posts staffed by health extension workers

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Maternal Health in Ethiopia

MMR: 676/100,000 live births (CSA, 2011)

NMR: 37/1,000 LB (CSA, 2011)

Skilled birth attendance: 10% (CSA, 2011)

0.05 midwife for every 100 expected deliveries

Majority of births take place at home with unskilled attendants

MMR per 100, 000 Live Births (Actual and Desired Trends for 1990–2015) (Source: MOFED, 2010)

So why are women not going to facilities?

Government has expanded numbers of facilities Very successful Health Extension Program at community

level Road access – still long way to go but has improved Deployment of ambulances to district level MNCH facility services are now free… Possible reasons – perceived poor quality of care, fear of

disrespectful care from providers

MCHIP interventions to address the problem

Service delivery interventions - Integrated Maternal & Newborn health (MNH) in 4 regions = 119 facilities (107 Health Centers & 12 hospitals).

Package of interventions centered on Quality Improvement Approach – Standards-Based Management & Recognition (SBM-R) verifiable objective standards to measure performance Providers & managers measure actual performance against standards &

identify gap filling to reach desired performance District health offices provided with small grants to support & facilitate

SBM-R Health centers provided with small grants to make facilities more

appealing to women

How is MCHIP addressing the problem?

Understanding the women’s perspective: Conducted literature review: Cultural Barriers to Seeking Maternal Health Care in Ethiopia; themes identified:

Views of pregnancy, childbirth & illness inhibit health seeking “illness a punishment of God; outcome pre-determined”

Health facilities for treatment not prevention

Lack of awareness by providers of special birth practices – prefer Traditional Birth Attendants, shared beliefs

Defining Respectful Care for Ethiopia

Key informant interviews with providers Providers asked to engage with women to define services: Cleanliness, well organized Kind, respectful providers “to be treated like I am her

sister” Have companionship during labor & birth Adopt position of choice for birth Warmth Ceremonies for coffee & porridge “Standardization” of MCHIP staff & mentoring of providers

Job Aids for providers

How can we measure respectful maternity care?

Use of performance standards & verification criteria e.g. • The provider helps client and her husband/partner develop

individual birth plan and complication readiness plan Attainment of standards measured during performance

assessments – baseline, 2 internal assessments, final assessment followed by recognition

Identifying key indicators for measurement within routine data collection e.g. measuring utilization

Results on Key Indicators

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65.3

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19.4

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50

60

70

Baseline Apr-Jun 2012 Jul-Sep 2012 Oct-Dec 2012 Jan-Mar 2013

Perc

enta

ge

MCHIP facilities: progress since baseline

ANC

SBA

PNC

Facilities response to integrating Women Friendly services

Re-organized services: all MNH services in one place, privacy Women receive tour of delivery/post-natal rooms during ANC Birth companion of choice into labor room Support birth position of choice Included important cultural aspects – coffee/porridge

ceremonies by relatives Religious blessings of facilities Post-natal room with bathroom: initiation of breastfeeding,

receive visitors, REST!

How facilities are putting in place Women friendly services

Traditional coffee hut; meeting place for pregnant women, waiting area for relatives of laboring women & place for coffee ceremony “Coffee is a part of our lives even when we are sad. It’s the first and last thing we do”

Mother Mary is with you in the delivery room

Opportunities

Increased awareness within Government of need to humanize services

Government initiatives to increase demand – Womens Health Development “Army”

Growing awareness of need to place greater emphasis on selection, recruitment and training of female midwives & entrants same region – language

Policy & service delivery integration opportunities

Thank you “They were friendlier this time and treated me like a sister. I labored in a room with comfortable beds, and after the delivery I went back to the room to rest” Makia, mother of 3. Two babies delivered in health center, last baby delivered since women friendly services had been put in place in her nearby facility in Oromia region