Addis Ababa, Ethiopia—Bizuhan Melese arrived at Gambella Hospital to give birth to her second child, fearful of what lay ahead. She had a complicated labor with her first baby, and the heartbeat of her second unborn child was faint. The doctor told Melese he would have to deliver her baby by cesarean section. Frightened at the prospect of surgery, the 27-year-old mother relied on midwife Meseret Gebre Michael for comfort, support and expert care.
“She even missed her lunch break to see me through my labor,” says Melese, who gave birth to a boy.
For her part, Meseret says she is humbled and empowered by the women who give birth at her hospital: “Every time I witness all the pain that a mother goes through to give birth to a child, I feel like I have accomplished a huge task to bring a new life into the world.”
Meseret’s professionalism, clinical midwifery knowledge and compassion for her clients have inspired her colleagues and helped strengthen health services at Gambella Hospital, a 96-bed facility located in the tropical zone in western Ethiopia where health facility utilization ranks as one of lowest in the country. Since attending the Jhpiego-supported training to update and enhance her clinical maternal and newborn skills, Meseret, 29, has taken a leadership role in improving the maternal health of her community.
The courses on basic emergency obstetric and newborn care (BEmONC) and prevention of HIV transmission from mother to child so engaged Meseret that she wanted to share her new knowledge and advanced skills with others and apply them throughout her workplace. As part of the BEmONC course, Meseret learned a range of skills and interventions, from basic infection prevention measures, such as proper handwashing, to the concept of mother friendly care, to use of the partograph as a decision-making tool.
“I felt so motivated to bring about change within my community and my facility. I started to put myself in every delivering mother’s shoes to share her pain,” says Meseret, a midwife since 2003 who now trains other health providers through a Jhpiego and Ministry of Health supported program. “BEmONC training was a good eye opener for me.”
When she returned to Gambella Hospital, Meseret and her colleagues were better equipped to identify clinical gaps and develop action plans so that they could increase the number of pregnant women and mothers who came to the hospital for care. In the Gambella region, the antenatal service coverage, attended delivery and family planning coverage are 19.8%, 12.3% and 5.2%, respectively.
As a Jhpiego-trained midwife and head of the delivery ward, Meseret led her staff in improving the use and availability of emergency drugs and delivery materials. Medications are now refrigerated, and she is currently in the process of securing a generator for the delivery ward because of frequent power outages in Gambella.
“She is doing so many things to bring change to the ward. For instance, the infection prevention work has shown quite an improvement, and woman-friendly care and partograph use have improved. In fact Meseret taught me how to perform vacuum deliveries,” says Samson Nigusie, a midwife in Gambella Hospital’s delivery ward.
The successes at Gambella Hospital are among the improvements in service delivery occurring as a result of Jhpiego’s work in building the capacity of health care workers across Ethiopia. Last year, Jhpiego introduced a Strengthening Essential Maternal and Newborn Care Program in response to the huge need to deliver quality BEmONC services in Ethiopia. Funded by UNICEF, the program is a strategy to build the competency of nurses, midwives and other health providers and reduce maternal and newborn deaths. With 470 maternal deaths per 100,000 live births, Ethiopia has one of the highest maternal mortality ratios in the world.
A national facility-based survey conducted in 2008 revealed that out of approximately 800 hospitals and health centers across the country, only 51 qualified as comprehensive emergency obstetric and newborn care (CEmONC) facilities, and only 1 percent of health centers actually provided BEmONC. Furthermore, it was apparent that health care providers at the facilities lacked the skills to deliver many of the BEmONC services that make up key functions.
Based on the survey’s findings, the Ethiopia Federal Ministry of Health decided to take the steps necessary to ensure health care workers had the competencies and the skills to carry out essential and emergency maternal and newborn care. UNICEF partnered with Jhpiego to carry out training activities and establish national training sites all over the country, a collaboration that has led to health system strengthening.
Jhpiego focused on the so-called developing regions and underserved areas in Ethiopia where capacity to provide clinical skills training for midwives, nurses and health officers is very limited. Jhpiego’s clinical training course is designed to prepare participants to manage obstetric emergencies and work effectively as members of a BEmONC team.
“This initiative is working to address the huge gaps identified in the delivery of EmONC services. In the rural areas of Ethiopia, the majority of women choose to deliver at home,” says Hannah Gibson, Country Director of Jhpiego Ethiopia. “One of the reasons that they choose to do so is because midwives and nurses in the health center are not considered to have the skills to deliver their babies. Equally, the midwives with their newfound confidence and up-to-date clinical skills feel motivated to encourage women to come to their health center for delivery.”
As part of its vision to establish a proficient health care cadre, Jhpiego plans to train a total of 2,000 midwives and nurse-midwives by mid-2013. In the first eight months of the program, more than 275 Ethiopian providers have been trained in the BEmONC program. These providers represent over 190 health centers and hospitals in eight of Ethiopia’s nine regions, and more than 40% of the trained providers are from emerging regions.
Hamdiya Mohammed, a midwife at the Karamara Hospital in Ethiopia’s Somali region, and five of her colleagues took part in the Jhpiego-led initiative last year, and she says it has made all the difference in the quality of the care they deliver now. Partograph applications, magnesium sulfate usage, newborn resuscitation, immediate breastfeeding and skin-to-skin contact between mother and newborn are just some of the gaps that Jhpiego’s BEmONC training has filled at Karamara Hospital, says Hamdiya.
“Before my BEmONC training, I relied on what I learned in my two years of study and what I saw from colleagues. Every day I am surprised by the difference I can make by applying the knowledge and skills I acquired in the BEmONC training,” explains Hamdiya. “Today, I believe and see that there is no delivery case that we can’t manage.”
It’s that level of confidence expressed by Hamdiya and her colleagues that is ensuring women and newborns in Ethiopia receive the care they need and deserve.