Proposal
Organization description:
Hamlin Fistula hospital is a world-class treatment facility for obstetric care and training of obstetricians to specialized surgeons. Rehabilitation programs assist former patients to reintegrate to village life. The organization also has a preventative strategy that aims to eradicate obstetric fistula from Ethiopia by providing trained midwives in the rural regions of the country. There are five regional Hamlin fistula hospitals throughout Ethiopia and an education program to teach midwives how to handle basic hygiene, simple antenatal care along with labor, and its complications in rural areas. There are over 500 staff members across various sites with Executive Officer Martin Andrews overseeing the day-to-day management of the organization. Hamlin Fistula hospital treats approximately 2,000 patients each year and more than 50,000 patients have been treated to date with a 95% closure of success rate.
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Funder Profile:
CARE is an NGO with a mission of empowering women and the betterment of women's health. An integral part of their community-based efforts is to improve basic education and increase access to health care of women while expanding economic equality for all. This international organization works primarily in rural areas of lower-income countries. Current projects such as Supporting Access to Family Planning & Post Abortion Care (SAF-PAC), focuses on the well-being of women in rural areas of five lower-income countries, such as Ethiopia, and provides them with post-abortion care and family planning. This project is similar to the Traditional Birth Attendant Initiative (TBAI) as it too serves as a tool to improve maternal health in the rural parts of Ethiopia. The TBAI will also play a large role in the empowerment of women in these rural areas. Traditional Birth Attendants (TBA's) will be able to bring mothers into healthcare facilities and inform them of different health practices and educate them on the importance of maternal health. The TBAI correlates with the goals of CARE, as this initiative similarly focuses on maternal health and the well-being of women in rural areas. Additionally, there are CARE offices located in rural Ethiopia, therefore the implementation of the TBAI would be seamless. ​
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Introduction:
The WHO millennium development goals have served as a major catalyst for countries worldwide to implement much-needed changes. Particularly, Ethiopia has implemented many new intervention programs such as the Health Sector Development program. This development program expands the reach of the healthcare facilities and increases the number of healthcare workers throughout the country. Although maternal mortality rates (MMR) in Ethiopia are lower than in previous years, it is still among the highest in sub-Saharan Africa. The Hamlin Fistula hospital requests $500,000 for the TBAI to help reduce maternal mortality through the education and training of TBA. This training will include, basic information on hygiene, simple prenatal and antenatal care, as well as possible labor complications. The goal of this initiative is to reduce maternal mortality in the rural parts of the northern region, Tigray, by 20% by the year 2030.
Statement of need:
Ethiopia has one of the highest maternal mortality rates in sub-Saharan Africa with an average of 497 deaths for every 100,000 women. Although there has been significant progress, hundreds of people, particularly in rural areas are still affected. A few of the many factors that affect maternal mortality are infrastructure, cultural, and traditional values. As Ethiopia is a low-income country, the infrastructure for its healthcare system, though improving, still has a long way to go. This, in turn, impacts the accessibility of water. Lack of clean water is one of the main contributing factors causing higher MMR in rural areas compared to urban areas. Nearly 61 million people in Ethiopia lack access to clean water and 65 million lack access to improved sanitation. This creates optimal conditions for the spread of infectious diseases such as hepatitis. In addition, this prevents people from being able to thoroughly wash their hands and contributes to the spread of diseases. This creates dangerous and non-sterile environments that have detrimental health impacts, especially on pregnant women as women in rural areas prefer to have home births. This is attributed to Ethiopian culture and tradition, which is highly dependent on community ties and relations.
Multiple studies concluded, the majority of women in rural areas prefer home-births with a TBA rather than going to a healthcare facility. One of these studies concluded that 78% of the women who participated, did not go to healthcare facilities. Of these women, 42% preferred TBA's over health care facilities because they believe going to healthcare facilities was unnecessary. Another 36% believed it was uncustomary/unorthodox. The remaining 22%, is divided by the lack of transport or high user fees at the healthcare facilities. Based on Ethiopia's DALY's, neonatal disorders are among the leading causes of communicable, maternal, perinatal, and nutritional diseases and conditions. Neonatal disorders accounted for 74.21 deaths/100,000 in 2017.
These issues are particularly present in the northern regions of Ethiopia. Tigray has the lowest doctor-patient ratios in the country. In 2014, there was one doctor for every 44,000 patients, whereas other regions had much higher ratios. There are 11 primary health care facilities, 16 general facilities, and a specialized hospital. In 2010, 80% of maternal deaths in Tigray took place in the home. Of this percentage, 50% of the deaths were a result of poor health-seeking behaviors, like those mentioned above. Additionally, when a mother dies, the consequences go far beyond the emotional toll on the family; it creates a financial strain as well. Another study indicated that a large percentage of families had to find financial support, whereas other families had to sell assets, or had to borrow money once the mother passed away. Maternal mortality also contributes to children's education getting interrupted, particularly that of young females, as they are forced to do domestic work. Lastly, it also contributes to the low survival rates of newborns. This initiative will be beneficial not only to help attain the Millennium development goal 5, which is to reduce maternal mortality but will also increase the overall well-being of people in these rural areas. In order to address the significant need for intervention for maternal mortality among women in Tigray, we propose training and education programs for TBA to decrease maternal mortality rates in northern Ethiopia.
Goals and objectives:
The overall goal of this project is to reduce maternal mortality by 20% in the northern region of Ethiopia, Tigray, by 2030 through training TBA's and eventually increase the number of mothers that give birth in healthcare facilities. The objective of this initiative is to achieve this goal by providing training and educational programs to the traditional birth attendants to help mothers throughout pregnancy and labor and advise them to go to healthcare facilities for pre and postnatal care.
Proposed intervention:
Similar interventions have worked in places such as St. Mary's Hospital in Urua Akpan, Nigeria. TBAs were educated on basic hygiene, antenatal care, labor, complications, and care of mother and child after birth. With a similar intervention, St Mary's received 320 more patents after the start of the program. They were able to see a 50% reduction in MMR among the women in the area where the study was conducted. Moreover, educating these women enabled the vaccination of 16,000 children.
These education programs would be done with the help of nurses from the Hamlin Fistula Hospital. The first step of the program includes educating TBA on the importance of pre and postnatal care. Following this, they will be educated on the physiological processes that occur during pregnancy to enable them to better identify any complications that may occur. Furthermore, during these training sessions, the TBAs would be educated on the importance of delivering children in a healthcare facility. Based on the current referral system in Ethiopia, the TBAs would be compensated based on the number of women they have referred to a healthcare facility. Incentives would involve increased financial support for TBAs whose patients have had the most follow-ups at the health care facilities as well as additional rewards and community recognition. This collaboration between the TBA's and the healthcare facilities will help better the referral system in rural areas as well as educate women on the importance of delivery in a healthcare facility.
Final Summary:
It is critical to accelerating efforts in reducing MMR in Ethiopia as it has one of the highest MMR in sub-Saharan Africa. Particularly in rural areas of Ethiopia, women are at a much higher risk of mortality due to the lack of sanitation. Nearly 60% of the population in Ethiopia lacks access to clean water. This prevents sanitary practices such as thoroughly washing hands and waste disposal, which creates optimal conditions for transmission of infectious disease. This has huge implications for MMR as many women in rural areas of Ethiopia prefer to have a home birth in the presence of a TBA rather than a healthcare facility. These birth attendants more often than not, have no training, and rely heavily on past experiences, making them unqualified to resolve situations should there be complications during delivery. Implementing this program will increase women's awareness of the benefits of healthcare facilities as well as help to empower women. This will substantially lower MMRs, as it will increase community connections to the healthcare facilities and highlight the importance of delivering children in clean environments while maintaining strong cultural ties.
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