Changing the place of birth from home to health facilities in Kafa Zone, Ethiopia

ABSTRACT

Women in rural and semi-urban Kafa Zone, Ethiopia are being encouraged to give birth in health facilities rather than at home. Using an earlier 2007 study as a comparison point, this study explored the role of Health Extension Workers (HEWs) in referring women to health centres for birth. Semi-structured interviews were conducted with 11 HEWs and 6 health workers in May and June 2014. The results show that women prefer birth attendants they know, including HEWs, and not to go to health centres or the hospital except for emergencies. The ambulance service linking rural communities with health facilities works better in some areas than others. To improve maternal health, HEWs need better support at the community level. Inefficiencies in the referral system should be addressed.

KEYWORDS:

• Maternal health
• Health Extension Workers
• referral system
• ambulances
• Ethiopia

Acknowledgements

Thanks to staff at the Kafa Zone Health Office, Lalmba Chiri Health Centre, Saylem Health Centre, to Temesgen Yohannis, Institute of Ethiopian Studies, Addis Ababa University who provided assistance as interpreter during many of the interviews, and most of all to the HEWs for their knowledge, opinions and time. The author wishes to thank Eva Poluha for reading and commenting on an earlier version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. The first 9 months of the 2006 Ethiopian financial year. There is a 7 to 8-year gap between the Ethiopian and Gregorian calendars. The Ethiopian year 2006 started in September 2013.

2. The informal insurance arrangement in case of funerals and other emergency situations.

3. One birr equalled 0.0498654 USD (2 November 2014).

Additional information

Funding

This work was supported by Australian Government Australian Development Research Awards Scheme (ADRAS) under AusAID Agreement 66420. The project is focusing on Improving the use of maternal, neonatal and child health services in rural and pastoralist Ethiopia.

Notes on contributors

Ruth Jackson

Dr Ruth Jackson is Visiting Research Fellow at the Alfred Deakin Institute, Deakin University, Geelong, Australia. Her background is in international development with research interests in maternal health and how the goal of reducing maternal mortality fits into Ethiopia’s development agenda. She is currently co-editor of a book by women in who have conducted research in Africa and is also researching the intersections between people, the montane rainforest in Kafa Zone, southwest Ethiopia, and food production for one of the Ethiopian Orthodox feasts.