Causes of Low Skilled - Birth Attendance Coverage in Selected Woredas of Amhara, Oromia and SNNP Regions

EXECUTIVE SUMMARY

This study was a benchmark for the three-year campaign dedicated to the Millennium Development Goal (MDG) 5’s 2015 target for improved maternal health, launched by World Vision Ethiopia (WVE). The Ethiopian government’s Growth and Transformation Plan (GTP) and the Global Child Health Now (CHN) campaign targeting health needs with a focus on the reduction of maternal and child mortality rates. This assessment presents the results of WVE’s research and informs policymakers and implementers of the GTP and CHN of the contributing factors impeding skilled birth attendance (SBA) in the Amhara, Oromia, and Southern Nations, Nationalities and Peoples’ (SNNP) regions. The study measured the existing benchmarks for SBA and related practises; reviewed the level of implementation and influence of existing national and regional health policies linked to skilled birth delivery; examined health facilities (HF) service availability and evaluated the causes of low skilled delivery coverage using policy gap, knowledge attitude and practise, and readiness assessments.

Methodology

The study was conducted using cross-sectional quantitative and qualitative methodologies to collect primary data such as household (HH) surveys; focus group discussions (FGD) per woreda (i.e. district); key informant interviews (KII) with regional health bureaus (RHB), woreda health offices and facilities, and communities; exit interviews with women who gave birth in the HFs; and service availability and readiness assessments (SARA). Secondary data and policies were studied as part of a desk review process.

Results

The Health Sector Development Programme (HSDP) IV was charged with the support of the GTP’s major sector development schemes, including the improvement in maternal and child health, combatting Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), malaria, tuberculosis (TB) and other communicable diseases, as well as the support of governmental policies, strategies and targets over the course of the project period (2011 to 2015).

As part of this movement, RHBs and regional governments were obligated to decrease the maternal mortality ratio (MMR) through the improvement of SBA. Towards this end, they assigned ambulance services in almost all woredas, provided maternity services free of charge, and made maternal and child health a public agenda through the use of health development armies (HDA) and health extension workers (HEW). As a result, antenatal care (ANC), delivery care and postnatal care (PNC) improved greatly throughout the region. Performance reports of the FMOH for 2013 to 2014 (EFY 2006) indicate that the ANC, SBA and PNC coverage, respectively, are 100, 32 and 65 percent in Amhara; 104, 48 and 74 percent in Oromia; and 94, 34 and 73 percent in SNNPR.

HH surveys and qualitative assessments showed improvements in SBA, but also revealed a low knowledge, at the community level, of how to recognise the danger signs of pregnancy; indicated that the transport of pregnant women from the community to HFs still presents challenges; and exposed the poor quality of services at the HFs. FGDs and KIIs exposed misunderstandings within the community about delivery care as well as cultural practises that impeded women from seeking institutional deliveries. Other hindrances to SBA were found to be the influence of men, elderly, mother- and father-in-laws, in some regions, as well as a fear of medical fees and scepticism of the condition of the HFs.

Conclusions

There has been a marked improvement towards increasing SBA coverage; however, the service quality provided by Health Facilities?? is not up to expectations. Poor infrastructure, inadequate and inconsistent drug supplies, a lack of basic equipment and inadequate human resources prevent health facilities from providing quality delivery services.

Recommendations

In order to improve SBA, RHBs and woredas administrations have to work together to support the community-level HFs by providing training on basic emergency obstetric and newborn care (BEmOC), availing drugs and supplies, and offering enhanced support supervision, particularly to health centres (HC).