By Kate Hawkins
The Quality improvement cycle will focus on community engagement, supervision and referral
This builds on the strengths of the existing system at multiple levels
REACHOUT research provide strategies to monitor and improve supervision policy and practice
REACH Ethiopia are working to improve the performance of close-to-community health programmes in Ethiopia (Health Extension Workers, or HEWs) through their first quality improvement (QI) cycle. Their overall focus is on improving supervision structures for HEWs and the community members engaged in work on health that they oversee, the Health Development Army (HDA).
There are a number of existing community engagement structures within the Ethiopian health system which the QI cycle will build on and seek to strengthen.
The Health Development Army facilitate a Pregnant Women’s Forum which all pregnant women in a Kebele should attend, as per government guidelines. In the Forum the family health card and Information, Education and Communications (IEC) materials are used to prompt discussion on safety and health during pregnancy and childbirth. These stress the importance of facility delivery and the danger signs to look out for during pregnancy and birth. This discussion is led by the HEWs and midwives and every woman has to prepare a birth and complication readiness plan.
The HDA leaders meet once a month. At these meetings religious leaders and other influential people in the community feedback on any health service issues or barriers that have arisen. They also play a role in identifying new pregnancies in their area and linking newly pregnant women to the HEWs. The HDA report to their HEWs – sometimes orally and sometimes in a written document if literacy is not an issue.
All HEWs are trained on Focussed ANC and on referral to the health centre (e.g. for HIV testing). Every woman should know the danger signs and the expected date of delivery. They use a standard checklist while providing ANC to pregnant mothers.
HEWs supervisors (the health centre focal people) and HEWs have been trained on supervision curriculum, maternal health, community engagement and coordination. Existing training materials have been adapted and used for further training. Trainers were drawn from Regional Health Bureaus, the Zonal Health Department, and the Woreda Health Office. Catchment Health Centre group supervision will be implemented and a group supervision guide will be provided for this. Individual supervision will be carried out every month using the checklist by the HEWs supervisors.
As part of group supervision referral sheets have been adapted and referral registers have been developed to support future tracking. A coordination meeting will be held with maternal health staff in hospitals and health centres to assess progress. Participant observation of the use of the ANC checklist has already occurred. This helped the team to understand how the ANC care was being provided before the training. They will do in-depth referral interviews and observation of community meetings as the QI cycle rolls out. The project is coordinated with the District Health Office.