Ethiopia-Canada Maternal, Newborn and Child Health Project (ET-Canada MNCH)

Improving Childbirth Outcomes in Ethiopia

Saving Lives of Mothers and Newborns by improving Birth Attendance and Referral Procedures

A key goal is reducing under-5 mortality by two-thirds

As many as 25,000 women in Ethiopia die in childbirth each year, and almost three times that many new newborns do not survive the first 28 days of life. Our collaboration of Canadian and Ethiopian colleagues will help reduce this appalling, medically unnecessary toll by building up the clinical and teaching skills in the country's rapidly expanding corps of midwifery instructors, and by targeting gaps in the referral system for difficult childbirth cases.

The project, which was launched in 2013 and began the first of four annual Senior Midwife Tutor courses in Addis Ababa in February 2014, is based at the University of Alberta in Edmonton, Canada and at St. Paul's Hospital Millennium Medical College (SPHMMC) in the Ethiopian capital. It is funded by the Canadian government through the Department of Foreign Affairs, Trade and Development, with large in-kind contributions from the Canadian partners.

The goal is to reduce maternal and perinatal mortality and morbidity in Ethiopia by expanding the reach and reliability of basic services and techniques that Canadians have long taken for granted. This Horn-of-Africa country has some of the worst MNCH (maternal-newborn-child-health) statistics in the world, with a maternal-mortality rate of 676 per 100 000 live births, a perinatal mortality rate of 85 per 1000 live births and an under-5 mortality of 104 per 1000 live births.

Of course, Ethiopia is already working flat out on a variety of fronts to achieve related Millennium Development Goals by 2015. This project was developed to support that drive, especially on MDG4 (reducing under 5 child mortality by two-thirds) and MDG5 (reducing maternal mortality by three quarters.) But huge challenges remain.

Maternal-mortality trends particularly affect women in rural and remote communities. In Ethiopia only 10 per cent of women give birth in health facilities, though great strides are being made to deal with this by both the government and NGOs. A large factor contributing to this problem is the shortage of midwives and skilled birth attendants. Our project will address these needs by focusing on three key areas:

  • Increasing the availability, access to and use of skilled birth attendants across the country;
  • Increasing access to and use of higher levels of expertise and hospital infrastructure for emergency births; and
  • Enhancing institutional environments to support sustainable, equitable and gender sensitive maternal, neonatal and child health services.

We began work in 2012, consulting in depth with local partners and creating wide networks of government, health and local leaders to determine baseline needs. From there we began developing a curriculum for "train-the-trainers" courses to cascade improved midwifery skills out into the country.

The midwifery component - the Senior Midwife Tutor Training Program, or SMTTP - is national in scope while the referral wing focuses on our catchment areas in parts of Addis Ababa, Amhara and Oromiya regions.

Our two partners in Ethiopia include SPHMMC and the Ethiopian Ministry of Health. Our major collaborators in country include the Ethiopian Midwives Association (EMA), the African Medical and Research Foundation, the Ethiopian Public Health Association (EPHA) and Addis Ababa University. Associated organizations include UNFPA, WHO, UNICEF, CARE, and the Hamlin Fistula Hospital (and Midwifery Program).

Leading the list of key Canadian partners is Mount Royal University of Calgary, home of Alberta's only degree program in midwifery and the key source of instructors for our annual SMTTP courses.

While the main project targets are midwifery skills and birth referral systems, the project will also provide a complementary strengthening of frontline caregiving, developing relevant competencies at St. Paul's Hospital (recently designated as a national referral center for Maternal and Child Health) and strengthening the EMA.

Project undertaken with the financial support of the Government of Canada

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