This IDRC funded multi year study focuses on the four principle health system barriers to safer motherhood. The study will be located in Jimma Zone, Oromia region and promising rates of social mobilization and community participation. Oromia region reports lower than national rates of skilled health care services and birth attendants. The great majority of women deliver at home with associated risks [3,7,8]. Our three intervention districts will be Dedo, Gomma and Seka Chokorsa. These districts were selected by our government partner co-PI because of their large populations,
Our focus of study will look at 4 highlighted areas:
1. Socio-cultural barriers
In the Ethiopian context, the common socio-cultural barriers reducing use of MCH services relate to traditional practices, including fear of michii (spirit possession or strike). They also refuse to seek institutional (health centre or hospital) delivery because of their dislike of giving birth in the absence of relatives, male dominancy in decision-making, and/or male power over the household resources including the cost of seeking institutional delivery, and fear of being treated disrespectfully by health institution staff .
2. Facility barriers
The physical presence of a health facility is not a guarantee of quality health service. Known facility barriers to MCH utilization include health workers’ authoritarian behaviours towards the women they see (which may be disrespectful); the absence of a suitable maternal waiting area where labouring women can rest and/or recover; and a simple lack of materials and medications required for the services provided. Moreover, the HEWs who work in the kebele health posts attend primarily to preventive aspects and are unable to manage complex clinical health problems.
3. Communication barriers
There are three principle communication barriers. The first barrier concerns improved information communication. The second barrier concerns the physical infrastructure for rapid communication, primarily mobile phone accessibility, wireless coverage and cost of use. The third barrier concerns improvements in the village-level knowledge and communication skills of the CDAs in promotion of safe motherhood behaviours in ways that are culturally appropriate and respectful.
I4. Transportation barriers
The most commonly mentioned MCH service utilization barrier is lack of transportation. Government policy is to distribute one ambulance per district to pick up women in labour and take them to the nearest health center. To use the ambulance the family has to pay 25% of the total required cost (the rest is covered by government)/ Sometimes the family may not have the amount of money required for this and so will delay travelling to a facility, risking greater complications.
The evaluation of the effectiveness of our identified interventions will include the following components and will be carried out at each point an intervention is introduced.
IMCHA Safe Motherhood Meeting in Toronto, November 20, 2018.