Increasing Access to and Use of Skilled Birth Attendants Using a Comprehensive Approach in Ethiopia

Introduction: Maternal and neonatal mortality represents enormous challenge in Ethiopia (MMR of 676/100000 & NMR of 37/1000 live births). With skilled birth attendance (SBA) coverage at 10%, the FMOH aims to increase coverage to over 60% to achieve the MDGs 4 & 5. The Integrated Family Health Program (IFHP) supports the FMOH efforts by implementing a comprehensive MNH strategy.

Objective:  To determine if delivering a comprehensive training and follow-up package to skilled birth attendants, coupled with community mobilization, increased use of skilled attended births.

Methods: Using a quasi-experimental study design, an intervention package of strategic steps was implemented chronologically. The program was initially introduced to district health offices to ensure ownership. IFHP then trained health center providers in BEmONC and; supplied facilities with medical supplies.  Frontline health providers were subsequently updated on specific topics like pre and post natal care, danger signs and birth preparedness. IFHP then conducted sensitization activities at district and community levels, and functional referral system was strengthened. Pre and post intervention data are derived from district-level health management information system (HMIS). 

Results: From the baseline of 2604 skilled attended births in 2011 in initial 5 districts (total population 627,257), skilled attended births increased by 34% (3470) after Year 1, and increased nearly threefold to 6181 by Year 2. Health facilities in the project area improved service quality. Two sites were nominated as model health centers by local government.

Conclusion: Selected evidence based interventions when implemented systematically improves access and utilization of services with skilled birth attendants.