Joint Programme Aims to Scale Up Efforts on Maternal and Newborn Health in Ethiopia

ADDIS ABABA, Ethiopia — Ethiopian health officials, the UN Country Team in Ethiopia and visiting UN Health 4 (H4) partners have, in collaboration with donor partners and others, developed a comprehensive three-year work plan (see details below) to support maternal and newborn health and survival in the country.

The H4 partnershiop represents an intensified joint effort by four international agencies, WHO, UNFPA, UNICEF and the World Bank, to support countries in improving maternal and newborn health and saving the lives of mothers and babies.

Ethiopia has one of the highest maternal mortality rates in Africa. According to the most recent estimates and findings only 6 per cent of pregnant women in Ethiopia have access to professional assistance during pregnancy and child birth, the lifetime risk for dying in pregnancy or childbirth is 1 in 27, compared to 17000 in Sweden, and the under-5 mortality risk is more than 1 in 10.

A 10-day H4 mission to Ethiopia concluded with a meeting in Addis Ababa on 9 December, involving UN agencies, officials from the Ethiopian Federal Ministry of Health, and the Health Population and Nutrition Donor Group – and a plan for how to tackle the challenges.

Scaling up and building momentum

“It was a very fruitful meeting and a very good visit to Ethiopia. The momentum and interest for taking action to save the lives of women and babies is truly there, and a good plan was developed,” said Dr. Luc de Bernis, Senior Maternal Health Adviser, UNFPA. He highlighted the strong leadership of the Minister of Health in Ethiopia, Dr. Tedros Adhanom Ghebreyesus, and the commitment in the donor community, civil society and the UN agencies, including UNAIDS, to join hands and implement the plan.

The Joint UN Flagship Program on Maternal and Newborn Health will scale-up the efforts in Ethiopia and focuses on both immediate and long-term interventions. It involves four strategies:

Increase demand, access and utilization of quality maternal and newborn health services
Improve the quality of maternal and newborn health services
Strengthen monitoring and evaluation of the services
Improve managerial and institutional capacity, advocacy and partnerships in order to encourage increased political and financial commitment to save the lives of mothers and babies.

Working together to save lives

About 50 per cent of all maternal deaths annually occur in sub-Saharan Africa, as do deaths among children under five. Since 1990, the number of estimated annual global maternal deaths has remained around 500,000, while the absolute number of child deaths in 2008 declined to an estimated 8.8 million from 12.5 million in 1990, the base line year for the Millennium Development Goals (MDGs).

During the coming years, the four agencies in the H4 will enhance their collaboration with and support to the countries with the highest rates of maternal mortality. Work is ongoing, with a special focus in six countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India and Nigeria). A joint work plan for scaling-up of national maternal and newborn health efforts in 25 countries and eventually to 60 countries is in the works.

The H4 is focusing on helping countries strengthen their health systems through developing maternal and newborn health services so that they can reduce the maternal mortality ratio by 75 percent and achieve universal access to reproductive health, the two targets included in Millennium Development Goal 5, to improve maternal health.

The joint effort will also contribute to reducing child mortality as called for by MDG 4, as there is a demonstrated link between a mother’s health and the survival, health and welfare of her children, particularly newborns. When a woman and mother is healthy and survive, her children, family, community and nation thrive.

Work Plan for Addressing Maternal and Newborn Health

The work-plan developed in Addis Ababa addresses the three pillars of maternal mortality reduction strategies:

1. Family planning:

Expanding the scope of contraceptives to be provided by health extension workers by introducing the long term contraception method, Implanon, in addition to pills, condoms and injectables. The H4 is planning to assist with the procurement and with careful monitoring and evaluation of this innovative programme.
Ensuring that all facilities with qualified health professionals, will have full scope of contraceptives in order to address unmet needs for family planning in an effective and timely manner.

2. Skilled Birth Attendance:

The midwifery programme: Supporting 8 out of the 23 midwifery schools through training of trainers, establishing of skill laboratory, strengthening of training sites and human resource planning at regional and district levels.
The Master programme: a collaboration between Ministry of Education and Ministry of Health, and five universities, to train health officers (non-physician clinicians-NPCs) in essential surgery including emergency obstetric care.

3. Emergency Obstetric and Neonatal Care (EmONC):

Addressing the equipment, supplies, and commodity issues of health centres (basic EmONC) and district/primary hospital (comprehensive EmONC), based on findings of a recent assessment.
At community level, health extension workers will be equipped with mobile phones, radios, and motor-ambulances, to ensure the referral system from community level to facilities.

The work-plan also addresses community participation, through a national conference on the topic, communications activities and a national launch of the African Union’s Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA).