Maternal Child Health and Nutrition

Maternal Health Case Team

Introduction

The maternal health case team is one of the six case teams of MCHN directorate of MOH. The case team deals with safe motherhood and other related reproductive health programs. It is established in 2013 under the directorate following the restructuring of the ministry into various program areas. This case team works closely with various case teams within the directorate and other directorates throughout the Ministry.

The maternal health case team currently coordinates and manages a number of projects and initiatives that aim to improve maternal health in Ethiopia.

The case team has a case team coordinator, five case team officers, and four technical advisors.

Purpose

To improve the maternal health status of the country by managing, coordinatingand leading various programs at all levels throughout the country.

Target (HSDP-IV and Visioning document):

  • Reduce MMR to 267/105LBs, 101.4/105LBs and 45.5/105LBs by 2015, 2025 and 2035 respectively
  • Increase skilled birth attendance to 62%, 77%, 95.1% by 2015,2025 and 2035 respectively
  • Increase ANC coverage (at least 4 visits) to 86%,77% and 87% by 2015,2025 and 2035 respectively
  • Met need for EmONC: 75% by 2015 and 100% by 2025

List of interventions

  • Emergency obstetric care
  • Quality maternal and newborn health care
  • Emergency obstetrics referral network
  • Maternal death surveillance and response
  • Elimination of obstetric fistula
  • Safe abortion service
  • Home delivery free Kebeles
  • Youth & adolescent RH(YARH)

Contact us:

  • P.O.Box: 1234, Ethiopian Ministry of Health

Maternal Death Surveillance and Response

Introduction

Maternal Death Surveillance and Response (MDSR) is a continuous surveillance linking the health information system and quality improvement processes from local to national level. It includes the routine identification, notification, quantification, and deter­mination of causes and elimination of all maternal deaths, as well as the use of this infor­mation to respond with actions that will prevent future deaths. Elimination of preventable maternal mortality is the goal of MDSR.

The Maternal Death Surveillance and Response (MDSR) approach provides the means to understand the underlying causes and factors that lead to maternal deaths, and develop appropriate solutions to save lives. This is done in an integrated manner using the existing Public Health Emergency Management (PHEM) system as a platform, and it is one of the twenty-one cases/events included in the Integrated Disease Surveillance and Response (IDSR) list of PHEM of Ethiopia.The MDSR was officially launched in May 2013 and its implementation is guided by national guidelines and training materials that are developed by the Ministry of Health and partner organizations.

Objectives/rationales

  • To provide information that effectively guides actions to eliminate preventable mater­nal mortality at health facilities and in the community
  • To count every maternal death, permitting an assessment of the true magnitude of mater­nal mortality and the impact of actions taken to reduce it.

Components/ strategic / interventions/activities 

  • Strengthen the integration of MDSR with PHEM IDSR system
  • Scale up MDSR to all woredas throughout the country
  • Review all maternal deaths identified through PHEM at all levels of the health system
  • Ensure appropriate responses are provided at community, health facility and health management levels (woreda, regional health bureaus and the MOH) in a multi-sectoral approach

Target

  • 100% of communities with zero monthly reporting
  • Identify 100% of deaths of women of reproductive age group (probable maternal death)
  • >90% of maternal deaths are notified (suspected or confirmed)
  • >90% of estimated maternal deaths are notified at woreda level

Time frame: Ongoing starting May 2013

Emergency Obstetric Care

Background

Low cost, evidence-based interventions exist for each of the main causes of death during pregnancy, childbirth and in the post-partum period. Ensuring that skilled birth attendants operating in teams in health facilities attend all births, and all women with complications have access to emergency obstetric care are the most proven interventions to avert preventable maternal deaths. Accordingly, one of the major initiatives of the maternal health case team is strengthening skilled attendance at birth and provision of adequate emergency obstetric care.

Objectives

  • Ensure all health centers and hospitals provide BEmONC and CEmONC signal functions respectively
  • Improve the quality of maternal health services
  • Strengthen Emergency obstetric referral service

 

Components/strategic activities/interventions/activities

  • Developand distribute service standards and protocols such as hospital and health center obstetric case management protocols and job aids, and SOP on emergency obstetric referral.
  • Human resource development: Developing training materials for, organizing and monitoring in-service training of health providers on BEmONC and CEmONC, midwife exchange and mentorship programs
  • Health facility strengthening: Equipping health centers and hospitals with EmONC equipment, supplies and drugs including operating theatre equipment.
  • Scale up the emergency obstetric referral service initiated in Addis Ababa to the regions
  • Collaborative work with the medical services directorate EHAQ initiative on establishing a maternal and newborn care quality improvement process in all hospitals. Actively engaged in ensuring application of facility self-assessment tool and mother-baby friendly service guideline development

Target

  • Increase the met need for EmONC to 75% by 2015 and 100% by 2025 and 2035
  • Provide BEmONC and CEmONC services in 100% of health centers and hospitals

Coverage/ achievement

  • 70.2% of all health centers currently provide BEmONC.
  • 54.7% of all hospitals currently provide CEmONC

Time frame

  • Ongoing since the initiation of HSDP IV (2010/11)

Improving Maternal and Newborn Health Care in Ethiopia

Introduction:

In order to meet the MDGs 4 and 5, it is essential to focus on the provision of an effective and integrated package of interventions at the base of the health system pyramid where work force, quality assurance and commodity supply chain are the weakest. This understanding has resulted in a partnership between the Ministry of Health and Children's investment Fund Foundation (CIFF).

The project mainly focuses on a set of primary elements: well-trained and well-supervised health care providers, ensured availability of essential commodities, and checklist to maximize quality assurance. This is believed to ultimately result in the provision of high quality service delivery at each level as well as increase health promotion and health seeking behavior in the community.

Goal

  • To improve the overall outcome in maternal and neonatal health (MNH) services and to contribute towards achievement of MDGs 4 & 5.

General Objective

  • Improve utilization and provision of quality maternal and newborn health services in selected 100 districts in four regions around the country.

Specific Objectives

  • Introduce the use of standardized checklist for institutional and home deliveries and home visits for newborn care
  • Build the capacity of health care providers by providing regular in-service training
  • Support social mobilization and IEC/BCC activities using the Health Development Army as a platform
  • Avail essential MNCH equipment and supplies, including essential medications.

Interventions

  1. Design and use standardized checklists for quality improvement
  2.  Capacity building of health care providers
  3. Mobilize and engage communities
  4. Avail essential equipment and supplies

Coverage

The project is implemented in 100 woredas (districts) in Oromia, Amhara, SRNNP and Tigray regions in a phased approach.

Time frame: 2013-2016

Donor: Children's Investment Fund Foundation (CIFF)

Contact us:

P.O.Box:1234,Ethiopian Ministry of Health

Email: mhexpert2.mh@gmail.com

Telephone: +1-251-115150407

Obstetric Fistula Elimination

Background

Fifteen percent of all pregnant women are estimated to develop life-threatening obstetric complications including obstetric fistula(OF). In 2013, the incidence of OF is estimated to be 3,500 per year.The total number of untreated fistula and urinary incontinence cases in 2010 were 37,500 and 161,000 respectively.However, in view of the recent high prevalence estimates of untreated fistula,the Ethiopian Ministry of Health has committed to accelerating the elimination of fistula by the year 2020(to make the prevalence of OF cases <1%) by employing a two-pronged approach. This approach will on one hand continue to implement on-going prevention strategies, while also intensifying identification, referral and treatment of OF cases to reduce the backlog.

Objectives:

The overall goal of this program is toeliminate obstetric fistula fromEthiopiaby 2020 by achieving the following seven strategic objectives:

  • Prevent obstetric fistula by improving equitable delivery of quality, integrated MNCH services at all levels
  • Identify suspected obstetric fistula cases and provide appropriate diagnosis, referral, and treatment.
  • Provide appropriate rehabilitation support for obstetric fistula patients based ontheir specific needs
  • Strengthenleadership, management and partnership to deliver coordinated, effective and efficient services at national, regional, zonal and woreda levels to achieve obstetric fistula elimination
  • StrengthenM &Eand research for evidence-based decision making
  • Develop and implement a comprehensive OF communication plan and strategy

Components:

Primary Prevention: Mainly through the prevention of unplanned pregnancies and adolescent pregnancies.

Secondary Prevention: Prevent and manage obstructed labor throughincreasedskilled birth attendance. Additionally, provide timely OF case identification and referral to fistula centers that are capable of providing appropriate and timely treatment.

Tertiary prevention: Rehabilitation and reintegration of women with repaired OF. Ongoing support should be given to those with unsuccessful OF repair.

Target:

Impact Target by 2020:  Decrease the prevalence of obstetric fistula to less than 1% by 2020

Outcome target:

  1. Increase community knowledge & awareness of OF
  2. Reduce unmet need for FP to <1%
  3. Increase skilled attendance at birth to 77%
  4. Increase coverage of BEmONC and CEmONC to 100%
  5. Increase identification, referral and treatment of OF cases to 100%

Process target by 2020:

  1. OF is on the agenda of Regional and Woreda health sector quarterly steering committee meetings. 
  2. OF is on the agenda of the Annual Review Meeting (ARM) of the FMOH
  3. OF targets are included in the HSDP and directorate/case team annual plans

Time Frame: 2015 to 2020(Six years)

 

Adolescentand Youth Sexual and Reproductive Health Service

The world is experiencing a surge of considerable proportion of adolescents and youth in the history of mankind. In Ethiopia this segment, considered between the ages of 10 and 24, constitutes nearly 34 % of the total population.

Adolescents and youth are capable of shaping the social and economic future of a country. The reproductive and sexual health decisions they make today will affect the health and wellbeing of their communities and of their countries at large.Accordingly, one of the major initiatives of the maternal health case team is strengthening the system to provide the best youth friendly reproductive health service to that segment of the population.

Objectives

  • Ensure all health centers and hospitals provide youth friendlyservice
  • Improveaccess and quality of youthfriendly services
  • Ensure all health centers have atlist two trained health careproviders that can provide youth friendly adolescent and sexual reproductive health service.

Components/strategic activities/interventions/activities

  • Establishmultisectoral coordination
  • Strengthen SRH services at university clinicsand health facilities
  • Strengthen health facilities by equipping health centers and hospitals with youth friendly services, as well as essential equipment, supplies and drugs.
  • Scale-up the integration ofyouth friendly services with FP

Target :

  • Provide youth friendly services in 100% of health centers and hospitals by 2015

Time frame

  • Ongoing initiative since the initiation of HSDP IV (2010/11)

Safe Motherhood Technical Working Group(SMH-TWG)

Introduction

The MCHN Directorate consists of five separate case teams, each supported by a technical working group. The Safe Motherhood TWG supports the maternal health case team under the MCHN directorate.

The SMH-TWG is instituted to technically support the Maternal Health case team with all aspects ofmaternal health, including antenatal, labor and delivery, and postnatal care as well as adolescent reproductive health. Within the TWG there are several task forces established as sub-teams includingEmergency Obstetric and Newborn Care (EmONC), Maternal Death Surveillance and Response (MDSR), Comprehensive Abortion Care (CAC), youth and adolescent RH, Elimination of Obstetric fistula (EOF)and Chronic Obstetric illnesses.The national SMH-TWG shall contribute to strengthening an integrated and comprehensive programmatic approach towards accelerating universal access and quality to essential safe motherhood (SMH) interventions.

Purpose/Objectives

The main purpose of the TWG is to provide enhanced and harmonized technical and advisory support to the maternal health case team of the Directorate on maternal and newborn health issues.

Specific objectives:

  1. Provide technical support to the maternal health case team and MCH Directorate on skilled care during pregnancy, delivery and postpartum, EmONC, MDSR, CAC,EOF and Chronic Obstetric illnesses;
  2. Support in improving SMH program coordination, harmonization, alignment and resource mobilization for better efficiency and effectiveness;
  3. Support program/service synergy and linkage within the various case teams.

Major responsibilities

  • Provide technical assistance to the directorate on the implementation of maternal health programs
  • Coordinate and followthe overall SMH program implementation and avoidduplication of programs
  • Provide evidence to the MH case team and MCH directorate for better decision making; and conduct operational research as well as epidemiological surveillance in the area of SMH;
  • Establishing various adhoc working subgroups accountable to the SMH-TWG as required
  • Conduct regular TWG meetings;
  • Review, adapt/adoptand develop nationalstandards, guidelines andtools for SMH
  • Document, share and scale-up best practices throughout the country

Member composition

The SMH-TWG has a broad base membership from the MOH, selected regional health bureaus (Addis Ababa and Oromiya), development partners, CBOs/NGOs, Professional Societies, Academic Institutions, and the private sector.

  • MOH: MCHN Directorate (Chair), Medical Services Directorate, EPHI, PFSA, Special support directorate, HR Directorate, Resource Mobilization Directorate
  • NGO's/UN Agencies: WHO, UNICEF, UNFPA, USAID, CDC, ICAP, JHPIEGO, FGAE, IFHP, Engender health, Intra-health, Marie Stops, MSH/HCSP, Hamlin Fistula Ethiopia, CHAI, JSI/L10K, Emory University, Ipas, DFID
  • Local Universities: AAU and other universities.
  • Professional Associations: ESOG, EMA (medical), EPHA, EMA (midwifery), ENA, ESA and others as needed.

Frequency of meetings:

The technical working group meets every other month, with extra meetings as needed.

Maternal, Child Health and Nutrition Trust Fund

Introduction

The implementation plan for selected life-saving commodities draws and builds on Health Service Development Plan (HSDP) IV and other ongoing initiatives such as the community based newborn care. It is developed in response to the current high maternal and neonatal mortality rates in the country, and based on the United Nations (UN) Secretary-General's Global Strategy for Women and Child Health. This UN strategy calls to end the inequitable access to life-saving medicines and health supplies encountered by women and children around the world and calls the global community to work together to save 16 million lives by 2015.

The Country Implementation Plan also conforms the government's commitment to accelerate the attainment of the MDGs 4 and 5. It represents Ethiopia's efforts to effectively integrate important global initiatives such as UNCoLSC, Child Survival Call To Action: A Promise Renewed (APR), Family Planning (FP) 2020 and others with a common goal of achieving and sustaining results for women and children in an efficient manner. It is also meant to provide further opportunity for strategic partnerships for increased investment in reproductive, maternal, newborn and child health.

The goal of the fund is to focus on access and availability of selected essential medications and supplies that will save the lives of women and newborns at all levels.

The overall objective of this Implementation Plan is to ensure the availability and use of 6 prioritized life-saving commodities for women and newborns. These six life-saving commodities are female condom, Emergency contraceptives, oral &injectable antibiotics, antenatal corticosteroid (ANCS),Chlorhexidine and Resuscitation Equipment.

Specific objectives set to be achieved by 2015 are:

  • Increase access to female condom in 60% of public health facilities
  • Avail emergency contraceptives in 80% of public health facilities
  • Increase the public demand and awareness for female condom and emergency contraception
  • Avail newborn health commodities in order to support the initiation and roll out of community based newborn care.

Interventions:

  • Registration of Chlorhexidine, Amoxicillin DT and Gentamycin 20mg/2ml
  • Identification of a credible supplier through competitive bidding
  • Procurement, shipment and distribution of female condoms, emergency contraceptives and essential newborn and child health commodities.
  • Preparation of distribution plan for public outlets
  • Monitoring CBNC roll-out
  • Post training follow-up of health care providers at Health Posts and Health Centers implementing CBNC, iCCM and, IMNCI
  • Institute innovative demand generation approaches to increase public awareness about emergency contraception, female condom and newborn and child health services

Coverage (at Woreda and community level):

CBNC interventions: The program is implemented in a phased manner along with the introduction of community based sepsis management. The first phase is already implemented in seven agrarian regions in Amhara, Tigray and SNNPR.

Time frame: 2013/2014 – 2015/2016

Donors: FMOH, MDG pool fund, UNICEF, WHO, UNFPA, L10K, IFHP, SC, USAID, SIDA, BMGF, JSI, CIFF, PATH, The World Bank, MANHEP, Jhpiego, CHAI, Packard Foundation

Maternal health Status in Ethiopia

Maternal and child health is one of the top priority programs of the fourth Ethiopian health sector development program (HSDP IV). Over the last four years Ethiopia has been implementing various programs to achieve the targets set in HSDP-IV, and MDGs 4 and 5. The ministry has applied a number of approaches to improve maternal mortality and morbidity in the country. Maternal mortality in Ethiopia is estimated to be 420/100,000 live births in 2013. Since 1990, there has been a 5.1% reduction per annum in MMR. However, Ethiopia still contributes tomore than 4% of the global maternal deaths, with an estimated 13,000 deaths in 2013.

Ethiopia has also shown marked improvement in antenatal care coverage, skilled birth attendant and postnatal care coverage, all of which directly contribute to significantly improve the maternal health condition of the country. Below is a graph depicting the progress over the past decade and half.

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