Community driven health and nutrition solutions for pregnant women and newborns in mobile communities
Supporting SDG 3: towards universal coverage
The Micronutrient Initiative (MI) is focused on improving nutrition for the world’s most vulnerable, especially women and girls.
From 2011 to 2015, as part of our efforts to improve women’s nutrition, MI worked with communities in Afar, in collaboration with national governments and partners such as the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), to increase access to antenatal care (ANC), birth care and postnatal care (PNC) for pregnant women and their newborns. This community-based approach included increasing access to essential healthcare services, medicines and other commodities, such as vitamins and minerals.
The lessons learned from the project in Afar, Ethiopia, could be adopted in other communities faced with similar challenges for pregnant women and their newborns.
The challenge in Afar, Ethiopia
Ethiopia’s health needs are among the highest in the world:
- maternal mortality rate is 676 deaths per 100,000 live births
- neonatal mortality rate is 37 deaths per 1,000 live births
In the Afar region of Ethiopia, these risks are particularly high, as the pastoral life means moving frequently in remote areas far from health facilities. In 2011:
- only 31% of pregnant women received antenatal care from a skilled health care provider
- 24% of pregnant women took iron-folic acid tablets at any time during pregnancy
- only 10% of pregnant women gave birth with a skilled attendant
To address this challenge, a series of approaches were taken to improve coverage and quality of care for women and newborns. Training for community-level providers and ensuring participation of facilyt staff in monitoring and quality improvement were key elements.
The approach also aimed to engage the community in creating innovative ideas and projects geared toward improving the health of mothers and infants, in order to further strengthen the link between the community and the facility.
This aspect included the development of quality improvement teams (QITs) and new training for traditional birth attendants (TBAs).
The TBAs were trained to identify pregnant women as early as possible, provide home visits and refer women to health facilities for quality ANC, birth and PNC.
The QITs were made up of elders, and community and religious leaders as well as representatives from the general community. Both QITs and TBAs were challenged with jointly identifying “change ideas” for their communities to improve uptake and quality of ANC, birth care and PNC.
Learn more about the project in Afar.
The project strategy in Afar involved engaging TBAs and community members in planning, implementing and monitoring maternal and newborn health and nutrition using the Collaborative Quality Improvement (CQI) model.
Sixty-five communities, or kebeles, developed CQI teams, which included community leaders, elders and religious leaders, as well as representatives from the general community.
Facility staff conducted monthly coaching visits to support the implementation of the change ideas, and identify and assess best practices.
This link between the community members and the facility staff strengthened communication and provided a platform to discuss other issues as well.
Through the continued involvement of the federal and regional ministries of health, the project has already expanded into two new woredas and plans are underway to expand even further. The facility and community QITs will be scaled-up across areas in six regions of Ethiopia.
Key highlights of the project results include:
- 27,090 women & newborns reached.
- 1,040 community & facility-based health personnel trained.
- 46 community-led & nine facility-led QITs identified “change ideas” to improve health and nutrition package-delivery for pregnant women & newborns.
- Outdoor community dramas on maternal, newborn health and nutrition performed in 20 villages. These were watched by more than 2,000 people. In addition, TV spots on pregnancy nutrition counselling aired 28 times across the region.
- More than 90 regional-level personnel and 71 volunteers were trained to improve monitoring data, resulting in 5,392 households registered for ANC, birth care and PNC.
- 671 pregnant women enrolled in the mobile health pilot study. The aim of the pilot was to help strengthen follow-up health checks via mobile text reminders.
- More than 10,500 pregnant women attended community-level education sessions to learn about health & nutrition throughout their pregnancy.
We worked with the following partners to address the challenge of how to effectively deliver, prove update of and monitor maternal and newborn health services at the community level for severely under-served areas:
- Ethiopian Ministry of Health
- Emory University, Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), USA
- University of Addis Ababa, Ethiopia