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Measuring Implementation Strength of Basic Emergency Obstetric and Newborn Care in 134 Health Centers of Amhara, Oromia, SNNP and Tigray Regions of Ethiopia

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Measuring Implementation Strength of Basic Emergency Obstetric and Newborn Care in 134 Health Centers of Amhara, Oromia, SNNP and Tigray Regions of Ethiopia Measuring Implementation Strength of Basic Emergency Obstetric and Newborn Care in 134 Health Centers of Amhara, Oromia, SNNP and Tigray Regions of Ethiopia The Last Ten Kilometers (L10K) Project JSI Research & Training Institute, Inc. PO Box: 13898, Addis Ababa, Ethiopia Tel: +251-11-6620066 Fax: +251-11-6630919 Website: www.l10k.jsi.com December 2015 Measuring Implementation Strength of Basic Emergency Obstetric and Newborn Care in 134 health centers of Amhara, Oromia, SNNP, and Tigray Regions of Ethiopia II Acknowledgements We would like to thank United States Agency for International Development (USAID) for funding the “Expanding Demand, Access to, and Use of Maternal, Newborn, and Child Health Interventions” Project and this survey. The implementation of this survey would not have been possible without the support of the Federal Ministry of Health (FMoH) and Regional Health Bureaus of Amhara, Oromia, Southern Nations, Nationalities and People’s (SNNP), and Tigray regions. We would like to acknowledge our colleagues for their contributions to all the steps of organizing and implementing the survey. We acknowledge the interviewers and the supervisors for their hard work, dedication, and for accomplishing the fieldwork on schedule. Finally, we take this opportunity to extend our gratitude to all study participants who took their time to respond to the survey questionnaires and provide us with valuable information. III Acronyms AMTSL Active Management of Third Stage of Labor ANC Antenatal Care APH Antepartum Hemorrhage BEmONC Basic Emergency Obstetric and Newborn Care BMGF Bill & Malinda Gates Foundation CEmONC Comprehensive Emergency Obstetric and Newborn Care D & C Dilatation and Curettage E & C Evacuation and Curettage FMoH Federal Ministry of Health HIV Human Immunodeficiency Virus IV Intravenous JSI John Snow, Inc. L10K The Last Ten Kilometers MDG Millennium Development Goal MMR Maternal Mortality Ratio MVA Manual Vacuum Aspiration PEE Pre-eclampsia/ Eclampsia PHCUs Primary Health Care Units PMTCT Prevention of Mother To Child Transmission PNC Postnatal Care PPH Postpartum Hemorrhage SBA Skilled Birth Attendant SNNP Southern Nations and Nationalities Peoples’ Region STIs Sexually Transmitted Infections USAID United States Agency for International Development WHO World Health Organization IV Table of Contents Acknowledgements ................................................................................................................................ III Acronyms ............................................................................................................................................... IV Table of Contents .................................................................................................................................... V List of Tables ........................................................................................................................................ VII List of Figures ........................................................................................................................................ IX Executive Summary ................................................................................................................................ X Background ............................................................................................................................................. 1 Objectives ............................................................................................................................................... 3 Methods .................................................................................................................................................. 4 Setting ................................................................................................................................................. 4 Design ................................................................................................................................................. 4 Data Collection.................................................................................................................................... 4 Data Analysis ...................................................................................................................................... 6 Ethical Clearance ................................................................................................................................. 6 Findings .................................................................................................................................................. 7 Health Workers Currently Working ..................................................................................................... 7 Availability of Essential Drugs ............................................................................................................ 8 Availability of Medical Equipment ...................................................................................................... 8 Maternity Unit Amenities & Infrastructure........................................................................................... 9 Infection Prevention Practices ............................................................................................................ 11 24 hours a day, seven days a week (24/7) Service Availability ........................................................... 12 Performance of BEmONC Signal Functions ...................................................................................... 13 Readiness to Perform all BEmONC Signal Functions on the Day of the Visit..................................... 15 Quality of care: Woman-centered Care, Partograph Use, and Stillbirth Rate ....................................... 16 Maternal and Newborn Health Services Provision .............................................................................. 17 Antenatal Care Services ................................................................................................................. 17 Delivery Care ................................................................................................................................ 18 Deliveries and Delivery Outcomes ................................................................................................. 20 Referral Services ............................................................................................................................... 21 Supportive Supervision ...................................................................................................................... 24 Providers’ Knowledge and Competency for Maternal and Newborn Care........................................... 26 Basic Characteristics and Experience of BEmONC Trained Health Workers .................................. 26 V Reasons for not Applying Skills for Maternal and Neonatal Care ................................................... 27 Knowledge and Competency in Pregnancy, Labor and Delivery Care ............................................ 28 Knowledge of Newborn Care ......................................................................................................... 33 Knowledge of Abortion Care .......................................................................................................... 37 Use and Quality of Partograph Completion and Labor Management................................................... 39 Discussion ............................................................................................................................................. 44 Conclusions and Recommendations ....................................................................................................... 46 References............................................................................................................................................. 47 Appendix............................................................................................................................................... 48 Appendix 1: Measuring Implementation Strength of BEmONC Care Assessment Tool ........... 48 Do you use a partograph in this facility? .......................................................................................... 65 Appendix 2: List of Zones, Woredas, and Health Facilities Studied .................................................... 73 Appendix 3: Performance of BEmONC signal functions by health center ........................................... 77 VI List of Tables Table 1: Data sources and techniques of data collection for measuring implementation strength of BEmONC, July 2015 ............................................................................................................................... 4 Table 2: Mean number of health workers currently available in selected health centers in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. .................................................................................................... 7 Table 3: Change in availability of essential drugs between baseline and follow-up surveys in selected health centers of Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. ........................................................ 8 Table 4: Change in availability of essential equipment between baseline and follow-up surveys in selected health centers of Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. .............................................. 9 Table 5: Change in availability
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