GHES LMIC Fellow 2016-2017
Home Institution: Jimma University, Ethiopia
U.S. Institution: Yale University School of Public Health
Project Title: Quality of Birthing Care in Low Income Countries: The Case of Ethiopia
This research project generally aims to: 1) describe the variation in woreda/district-level skilled birth attendance rates (SBA) measured by the Health Management Information System (HMIS)in Ethiopia in 2015, 2) identify woreda/district-level determinants of higher SBA rates, and 3)examine the quality of labor and delivery (L & D) services in the government hospitals of Southern Nations Nationalities and Peoples Region (SNNPR). For aim 1, data will be obtained from the databases of HMIS, Education Management Information System (EMIS), and Central Statistical Agency (CSA). For aim 2, primary data on structure, process, and outcome quality measures pertaining to L & D services will be collected for all hospitals in SNNPR. These measures will be consistent with the Ethiopia Hospital Alliance for Quality (EHAQ) measures of L& D services. EHAQ is a learning collaborative based on a model that involves hospitals exchanging knowledge with each other and empowering the hospital industry to teach itself how to improve (MOH, 2014a); in 2014-2015, EHAQ is focused on improving hospital quality of are relative to L & D services. Consistent with EHAQ recommended strategies, the structure measures of quality include an inventory of the required resources (e.g., equipment, medicines,and guidelines). Process measures include the use of proper registration, triage, rapid assessment, and newborn care practices, which will be assessed by site visits and observation of providers’ practices. The outcome measure will be the EHAQ assessment of maternal satisfaction.
Findings from this research can help Ethiopia identify factors associated with success in increasing skilled birth attendance rates as well as identify critical gaps in quality of hospital care to be addressed as they continue improving maternal, newborn, and child health. As Ethiopia seeks to be a middle-income country within the next 30 years, improved quality of hospital care will be fundamental to such development. Although less than 20% of mothers giving birth in facilities, this number is likely to triple in the next 30 years. A more thorough understanding of the factors associated with skilled birth attendance rates and of the quality of hospital labor and delivery service is paramount to creating a health care sector that will support Ethiopia’s development agenda.