Catalysing change in Ethiopia's health system

In 2013, Options’ Evidence 4 Action (E4A) programme supported the Federal Ministry of Health in Ethiopia to introduce a national Maternal Death Surveillance and Response (MDSR) system. Today, MDSR happens in every region across the country and maternal death has become a mandatory condition to report within the country’s Public Health Emergency Management system.  Over the first four years of implementation, MDSR data has contributed to significant and life-saving changes to the Ethiopian health system. These have included:

• Supporting a national programme providing maternity waiting homes for pregnant women, which has improved facility access for women from hard to reach rural areas.
• Increasing the number of intensive care units from 10 to 250 in hospitals across the country. This has improved quality of care to women and babies who experience life-threatening complications during and after birth.  
• The procurement of 3,000 ambulances across the country which will improve referral systems.
• The development of a national safe blood transfusion strategy.
• The development of a national action plan to eliminate preventable obstetric haemorrhage deaths in the country, enhancing government commitment and increasing resources to address the problem.
• Multiple projects to improve facilities, such as increasing operating theatre capacity. This has resulted in a drop in “delay from decision to incision” for obstetric complications.

E4A supported the Federal Ministry of Health to produce MDSR guidelines, establish an MDSR National Task Force to own these guidelines and develop a national MDSR training programme that has been rolled out to clinicians, managers and policy-makers at zonal and health facility level. Working through the World Health Organisation (WHO), E4A has supported the establishment of a National MDSR database. Furthermore, MDSR training has been extended into the pre-service training for health extension workers, midwives, obstetricians and gynaecologists and field epidemiologists.

“In the Ministry we used to use annual reports, which were not evidence-based, for planning. The data was poor. But after introducing MDSR we started producing policy briefs; 15 in the first year, four from MDSR data. It was like a scientific conference, it was eye-opening for other programmes as well.” Dr Azmach Hadush, MNCH Coordinator, WHO

E4A’s approach is catalytic. It continues to provide global technical expertise combined with a few advisors based in Addis Ababa and some located in the regions, hired through WHO. These advisors work with the Ethiopia Public Health Institute and Federal Ministry of Health to:

• Strengthen the collection, analysis and use of evidence from the Maternal Perinatal Death Surveillance and Response System (i.e. now including perinatal death).
• Collate information in formats accessible to decision-makers and with clear and actionable policy recommendations.
• Facilitate action and decision-making based on MPDSR data at facility, regional and national levels to address quality of care gaps.