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Blood Pressure Device Trials
We have recently completed a pilot project in Gimbie region, evaluating low resource blood pressure devices in this setting. We have validated a suitable low cost device for use in the environment (accurate, robust, minimal maintainence, manual inflation pump, can be used by non trained personal - accepted for publication.) Raised BP is a major risk factor in pregnancy for pre-eclampsia, a largely asymptomatic disease causing serious morbidity and mortality to both mother and baby, yet easily treated in this environment e.g. by delivery of the baby. It is unheralded, and we have determined that untrained personnel based in the community can use such devices. We propose a larger study to investigate whether training and introduction of such devices in large areas previously without any form of BP screening will result in referral and interventions to prevent serious disease to mother and baby.
Programme Evaluation
Mimi Khan conducted an independent evaluation of the Maternity Worldwide Gimbie Integrated Maternal Health Programme in West Wollega, Ethiopia. From October 2006 to March 2009, this programme was supported by the Big Lottery Fund and based on the WHO Three Delays Model which emphasises that deaths during pregnancy and childbirth are, in the main, due to delays at community and health facility levels.
A summary of the main findings of the evaluation are provided here. Full copies of the evaluation report are available on request.
The programme achieved outstanding results in a relatively short time frame. There was a substantial year on year increase in the number of women attending Gimbie Adventist Hospital for deliveries, which included those with obstetric complications. Antenatal attendance also increased substantially during the programme life. Maternity Worldwide established an obstetric database to support the hospital's monitoring system and all details of maternity admissions were subsequently recorded. It has also developed a successful maternal death tool used to audit maternal deaths and, with improved procedures by Year 2, the case-fatality rate had fallen.
The women's income generating project was extremely successful. The main activities selected by women beneficiaries were animal rearing, petty trading, gardening and a small number undertook cotton spinning and other activities. Nearly 80% of those women who started activities in Year 1 of the project have paid their original loan back and most had made a profit. Before the project many of these women had collected firewood for a living. The loans which were paid back were revolved so that new women's groups could be established.
Much of the success of this programme was due to the implementation model used by Maternity Worldwide which comprised of three steering groups to oversee the various activities. and whose members comprised of different governmental departments, NGOs and faith based organisations. The steering groups included representatives with a wide range of technical skills including health, agriculture, vetinary and social services. Representatives from the Woreda Women's Affairs department were particularly committed and active in the steering committees. These committees oversaw the implementation of programme activities including monitoring activities. This was the first time that such an integrated way of working had been undertaken in West Wollega and its members were very enthusiastic to reproduce this way of working in the future with other health-related programmes.
It is clear from the visits to a sample of programme kebeles during the evaluation that the programme has had a positive and beneficial impact on the status, financial security and rights of women beneficiaries. The impacts were wide-ranging with benefits relating to family health, children's schooling, women's economic status (including increased income and savings), social standing and peace of mind. The profits made from the income generating activities had had a clear positive effect on women's ability to travel to hospital for delivery and pay a contribution for any medical procedures necessary. In several of the kebeles visited beneficiaries reported that they had started up other women's savings and credit associations drawing on the skills provided by the project.
A community health education programme was also rolled out to community members in the programme kebeles and was undertaken by the government health extension workers with support from Maternity Worldwide. Health education was given to groups of community members at a range of different venues and also carried out from house to house. Activities significantly over performed against the original targets including the number of sessions given and the number of community members attending these sessions. Focus group discussions undertaken during the evaluation visit to a sample of programme kebeles showed a noticeable change in the knowledge, attitude and behaviour of beneficiaries. At the end of the programme period responsibility for the ongoing implementation of the women's income generating groups and community health education project was handed over from Maternity Worldwide to the relevant government zonal departments. This will help promote the sustainability of the programme.It was clear that there was high participation at all levels of the programme: from the steering committees right down to the communities.
Capacity building has taken place throughout the programme including building the capacity of those who participated in the three steering committees, health staff at the maternity unit at Gimbie Adventist Hospital and the rural clinics, and women beneficiary and kebele leaders in the communities (who received training on income generating projects and community health education).
The Maternity Worldwide programme has successfully upgraded the requisite equipment at Gimbie Adventist Hospital so that it can now function as a comprehensive emergency obstetric care facility. The equipment was purchased and installed in the face of many logistical difficulties.
The strengths of the programme include the huge achievements made in a short period with a limited number of personnel. This is the only safe motherhood project in this zone providing hospital lbased emergency obstetric care in addition to community activities. The programme has been well implemented in spite of many obstacles faced including the remote and mountainous programme area, the difficult journey to Addis Ababa and the difficulty of attracting qualified obstetricians to this area. The hospital and clinics are now fully equipped with the relevant equipment. The formation and management role of the three programme steering committees in the programme implementation is unique in this zone and provides a good future model and will contribute to the programme's future sustainability. The involvement of kebele leaders at the community level has helped to tap their invaluable experience of their own communities when planning the programme and to later mobilise communities. The women's income generating projects and the community health education project have had a wide reach.
The programme weaknesses and constraints include the short time frame originally allotted, the shortfall in real spending money due to the recent worldwide economic downturn, the high turnover of programme staff, the weak link of the rural clinics in the three delays model and the need to adopt a behaviour change communication model to improve health education delivery and make it more participatory.
