In resource-poor countries, newborns and their mothers rarely get adequate medical care. Despite Ethiopia's efforts to improve maternal and child health to meet the United Nations's Millennium Development Goals, for instance, the death rate among infants declined only slightly from 2005 to 2011, and more than 18,000 Ethiopian women still die during or after childbirth every year. But a recently completed three-and-a-half year pilot program funded by the Bill and Melinda Gates Foundation suggests that when entire communities work together, mothers and babies are more likely to receive the care they need.
One of the biggest barriers to good health care in sub-Saharan Africa is access: Most people live in rural areas, which can have as few as one health center per 25,000 residents. Since 2005, the Ethiopian government has trained more than 33,000 health extension workers to provide basic preventative health services to rural areas, but the workers focus mainly on immunization, sanitation and family planning, so "women in the communities don't see them as being providers of newborn and maternal health care," says Lynn Sibley, director of the Center for Research on Maternal and Newborn Survival at Emory University and the principal investigator of the new pilot program, the Maternal and Newborn Health in Ethiopia Partnership. To address this problem, the program provided extra training to workers in two Ethiopian regions so they could more confidently assist with care before, during and after childbirth.
But "it's one thing to have the knowledge and skills for a safe and clean delivery - we also have to identify who's pregnant and get them linked into care," Sibley explains. To do this, the project recruited community leaders - priests, agricultural leaders and women's association members - to brainstorm and test ways to identify expectant women in their villages and get them registered. Participating communities also aired television and radio shows to encourage pregnant women to seek medical assistance. Finally, because most Ethiopian births take place at home and without the presence of skilled providers, the project organized training sessions for pregnant women and their families to teach obstetric first-aid basics.
The combination of these approaches proved promising. In Amhara, a rural region in northwest Ethiopia, fewer than half of all pregnant women received prenatal care prior to the pilot program, but that number rose to 81 percent afterwards. More than twice as many Amharan childbirths were assisted by health workers after the program, too. Most important, the rate of maternal and neonatal deaths began to drop nine months after the program began. Now the initiative is being tested in additional regions in Ethiopia, with the hope that similar community-based approaches could eventually address other fundamental gaps in health care in sub-Saharan Africa, where life expectancy is still 20 years lower than it is in the U.S. and Europe.