Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia

Ruth Jackson, Fisaha Haile Tesfay, Tesfay Gebregzabher Gebrehiwot, Hagos Godefay

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives: To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia. Methods: A key informant study was conducted with 44 Health Extension Workers in Afar Region, Kafa Zone (Southern Nation, Nationalities and Peoples’ Region), and Adwa Woreda (Tigray Region). Health Extension Workers were trained to interview women and ask for stories about their recent experiences of birth. We interviewed the Health Extension Workers about their experiences referring women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care. Data were analysed using thematic analysis. Results: Themes related to reducing the first delay, such as the tradition of home birth, decision-making, distance and unavailability of transport, did not differ between the three locations. Themes related to reducing the second delay differed substantially. Health Extension Workers in Adwa Woreda were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances as they were used for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they need to travel to health facilities for Emergency Obstetric and Newborn Care. Conclusions: Initiatives to reduce delays can improve access to maternal health services, especially when Health Extension Workers are supported by the Health Development Army and a functioning referral system, but district (woreda) health offices should ensure that ambulances are used as intended.

Original languageEnglish
Pages (from-to)148-160
Number of pages13
JournalTropical Medicine and International Health
Volume22
Issue number2
DOIs
Publication statusPublished - Feb 2017
Externally publishedYes

Keywords

  • Ethiopia
  • Health Extension Workers
  • maternal health services
  • referral
  • skilled birth attendance
  • three-delays model

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