Empowering Catchment Health Center to Deliver Comprehensive and Safe Obstetric Care Near Clients’ Home: An Institutional Experience in Ethiopia

Figures & data

Figure 1 Conceptual framework showing how an improvement science result in an improvement in maternal service delivery by empowering a health center.

Table 1 Phase One - Initiation of the Project

Phase	Milestone	Time Frame
Phase-1: Initiation	Based on the catchment health center referral audit, a project to capacitate one of the highest-referring health centers was planned	December 1, 2020
	The project proposal was developed and presented to the senior management team of SPHMMC	December 5, 2020
	Senior management team with the quality team visited Anne Dimma health center	December 7, 2020
	The senior management team approved the project proposal	December 9, 2020
	MOU between SPHMMC and Anne Dimma health center was signed	December 10, 2020
	A multi-disciplinary team from the Senior management team, Quality improvement and clinical governance directorate, Obstetrics and gynecology and Anesthesiology department, Engineering unit, and Anne Dimma health center was established	December 12, 2020
	The multi-disciplinary team visited Anne Dimma health center	December 13, 2020
	An action plan by a multi-disciplinary team was developed	December 16, 2020

Abbreviations: MOU, Memorandum of Understanding; SPHMMC, St. Paul’s Hospital Millennium Medical College.

Table 2 Phase Two - Implementation Strategy of the Project

Phase	Milestone	Time Frame
Phase-2: Implementation	After workforce analysis was done, the required human resources and necessary equipment were quantified by a multi-disciplinary team	December 20, 2020
	The senior management team approved the plan	December 22, 2020
	Required equipment mobilized (operation table, anesthesia machine, operation light, cesarean section set, delivery set, drape set, scrub gowns, beds, portable oxygen, and ultrasound machine)	Dec 22–30, 2021
	Training on comprehensive maternal and neonatal care for health officers, midwives, and nurses working at Anne Dimma health center was given	January 02, 2021-March 25, 2021
	Facility redesign was done by the SPHMMC engineering team	Jan 3-Feb 30, 2021
	C/S operating theater equipment was installed by the biomedical engineering team	Jan 1-March 25, 2021
	Facility preparedness and readiness assessed by the Quality improvement and clinical governance directorate from SPHMMC	April 10–13, 2021
	Facility preparedness and readiness assessment was presented to the senior management team of SPHMMC	April 15, 2021
	The senior management team and multi-disciplinary team revisited Anne Dimma health center and feedback was given	April 16, 2021
	Representatives from MOH and the Oromia regional health bureau visited Anne Dimma health center and feedback was given	April 21, 2021
	Comprehensive obstetric care service started at Anne Dimma health center	May 17, 2021

Table 3 Phase Three and Four – Monitoring & Evaluation and Sustainability Plan

Phase	Milestone	Time Frame
Phase-3: Monitoring & Evaluation	A clinical audit was done on a monthly basis	June 2, 2021-January 30, 2022
	Supportive supervision was done every two months by the SPHMMC quality and clinical governance directorate
	Supportive supervision result was presented to the senior management team and feedback was given
	The senior management team revisited the project site two times
Phase-4: Sustainability	A sustainability and exit plan were prepared and a discussion was held with the Oromia regional health bureau	January 20, 2022

Abbreviations: SPHMMC, St. Paul’s Hospital Millennium Medical College.

Figure 2 Monthly total and cesarean section delivery at Anne Dimma health center from April 2021 to April 2022.

Abbreviation: C/S, Cesarean Section.

Figure 3 Monthly total and cesarean section deliveries at SPHMMC from December 2020 to April 2022.

Abbreviations: C/S, cesarean section; SPHMMC, St. Paul’s Hospital Millennium Medical College.

Figure 4 Total number of monthly maternal referral-out from and referral-in to Anne Dimma health center from April 2021 to April 2022.

Abbreviations: R-I, Referral in; R-O, Referral out.

Figure 5 Total number of monthly obstetric ultrasounds done for clients who had antenatal follow-up and safe abortion service delivered at Anne Dimma health center from April 2021 to April 2022.

Figure 6 Total number of pregnant women that received antenatal care at least once and four visits on a monthly basis from April 2021 to April 2022 at Anne Dimma health center.

Abbreviation: ANC-Antenatal Care.