Improving the Referral System


The objective of the referral wing of our project is to improve procedures for handling of both normal and emergency birth situations, and to boost the capacity of health institutions at all levels to support maternal, neonatal and child health services. While the project's work to augment midwifery training in Ethiopia is national in scope, the referral effort will focus on Addis Ababa, Fiche (the North Shoa Zone) and areas yet to be identified in Amhara and Oromiya regions.

Two of the main contributors to high maternal and infant death rates in Ethiopia are the lack of access to quality health care - both in terms of competent personnel and properly equipped facilities, particularly in rural areas - and poor systems for transferring delivering mothers to higher levels of care when emergencies arise.

We'll endeavour to address these problems by focusing our activities on several fronts: 1) Increasing access to and use of skilled birth attendants; 2) Improving the coordination and use of an improved referral system; and 3) Helping organizations and institutions that support maternal and child health services, and in particular the Ethiopian Midwives Association.

Helping Babies Breathe

Helping Babies Breathe (HBB) is a program that teaches the essential skills of caring for healthy babies and assisting newborns who are initially unable to breathe on their own.
In 2013, HBB training was our project's first real output, offered at both St. Paul's Hospital Millennium Medical College and Fiche Hospital.

Our goal is to ensure that everyone involved in the delivery and birth process in these facilities is trained in HBB, including doctors, residents and nurses in both the pediatric and obstetric departments. In 2014, further sessions were given in Fiche and to students of our Senior Midwife Tutor Training Program in Addis Ababa. Another was scheduled at St. Paul's in November.

A Quality Improvement Workshop was also slated for St. Paul's in November; it is tailored to support the group responsible for overall implementation of the HBB program in the hospital. The goal of this team is to ensure that in future, no baby is born in the hospital without HBB-trained personnel and proper equipment on hand. A similar process will be undertaken in Fiche.

Data Collection

As training and needs assessments are completed at all levels of the health system in our catchment areas, essential equipment will be purchased where necessary. Staff has been hired to support this effort: A data collection officer will work in the obstetrics and pediatric departments at St. Paul's; a field data collection officer will play the same role in the project's other target regions.

Micro Research and Continuing Education

Micro Research training is an important part of our project. As well as being a component of the annual SMTTP course, it was the subject of a separate course - taught by Dalhousie University's MicroResearch team - presented to a multidisciplinary group of 30 participants at SPHMMC in October 2014.

The goal of this initiative is to build capacity for community-based health research. As part of the training, participants worked in groups to identify problems and develop research proposals to investigate their ideas. Funding and mentoring is available for them to assist them in collecting data and developing solutions to the challenges they have tackled. Five groups from the October course already have micro-research proposals on the go.

Recent Activity

In the summer of 2014, the Addis Ababa Project Office team visited Fiche Hospital, two Health Centers and four Health Posts in the area. They met with zonal directors, facility heads, midwives, health extension workers, MNCH department staff and supervisors. They also visited the facilities and considered opportunities for future training, checked out supplies of materials and equipment and reviewed documentation such as registration books and log sheets.

Additionally, a graduate student from University of Saskatchewan is currently in the field working with our office staff and the recently hired data-collection team to assist in setting up our Referral Strategic Plan. He'll set up preliminary meetings with people involved in emergency referral in our catchment areas and with them report on improving current procedures.

Project undertaken with the financial support of the Government of Canada dfatd logo