Opportunities and challenges to embedding quality improvement into the Ethiopian health system

Daniel G. Datiko, MD, PhD REACH ETHIOPIA June 12, 2016, BRAC, Bangladesh

Ethiopia - maternal health 4th highest maternal mortality: 676 /105

LBLow institutional delivery High attrition from 1st to 4th ANC attendance

Background

• Launched Health Extension Programme in 2004

• Recruited female Health Extension Workers

• Improve access to primary healthcare

• Provide curative, preventive and promotive health services

Background

• Baseline context analysis was carried out to identify barriers and facilitators for Health Extension Workers’ performance on maternal health Focus - improving the quality of Antenatal Care provided by the Health Extension Workers and linking mothers to facility delivery

Baseline

• Quality improvement intervention

• Improve community engagement

• Pregnant Women’s Forum and Health Development Army leaders

• Strengthen supportive supervision

• Improve referral linkages

Intervention

• Capacity building: Health Extension Workers and supervisors

• Provided guides: Pregnant Women’s Forum, Health Development Army and supervision

• Developing supervision checklist and referral slips

• Facilitated implementation in the community

Main activities

Monthly performance report ፡ HP, HC and WoHOQuarterly data collection Joint supportive supervisionPerformance review meeting

Monitoring and Evaluation

• Improved Health Extension Workers’ knowledge and skill about Antenatal Care

• Increased checklist supported supervision • Increased attendance of mothers in Pregnant

Women’s Forum • Improved use of guides, registers and referral• Improved service utilization: referral uptake and

skilled delivery

Key results

The trend of pregnant women identification by Health Development Army

• Maternal health is top priority and commitmentAvailability of Health Extension Programme policy, guidelines and standards

• Organization of Primary Health Care Unit: Health Development Army, Health Extension Workers and supervisors

• Long standing partnership and stakeholders engagement

Opportunities

• High turn over of Health Extension Worker supervisors

• Motivation of the Health Extension Workers and the Health Development Army

• Inadequate logistics and basic facilities • Limited experience about QI interventions

Competing priorities

Challenges