MNH realities in rural areas

Although several initiatives to prevent maternal deaths are implemented in Ethiopia, a robust confidential enquiry into maternal deaths (CEMD) has not been conducted since 1983. We introduced CEMD at the regional level in eastern Ethiopia to establish the feasibility of a (regional) CEMD and identify the benefits of such an approach. The study identified that 27/59 (46%) and 15/59 (25%) of the reviewed maternal deaths were caused by obstetric haemorrhage and hypertensive disorders of pregnancy, respectively. In 55/59 (93%), at least one of the three delays was identified: delay one (seeking care) in 48 (81%), delay two (reaching an appropriate facility) in 52 (88%), and delay three (receiving adequate care) in 54 (92%). Almost all the maternal deaths were preventable with better care. Training for improving providers’ clinical skills, improving the availability of blood and basic supplies, strengthening postpartum monitoring, and referrals could reduce preventable maternal deaths.

Pastoralist communities in Ethiopia's Afar and Somali regions face high maternal and neonatal mortality due to limited infrastructure, mobility, and poor access to care. The SLL-360 program is adapting a Hub-and-Spoke Network of Care (NoC) model to improve service delivery by linking hospitals, health centers, health-posts, and communities. This implementation research (2024-2027) tests a package of integrated clinical mentorship, biomedical device support, data use, and quality improvement within a tiered referral system. Key services include labor, NICU, KMC, and provider training, with strong engagement of community and religious leaders. Early findings from a baseline assessment show functional neonatal units but major gaps in diagnostics, infection control, staffing, power, and protocols. These insights have guided targeted interventions in four hospitals and seven health centers. Initial results indicate the NoC model is feasible and relevant, but sustained impact requires continued investment in mentorship, infrastructure, and community-facility linkages.

CMMB Kenya, a local faith based global health and development organization, in collaboration with the Kitui County Ministry of Health, and World Bicycle Relief, implemented a capacity building and mobility initiative targeting CHPs in Mwingi North sub county to improve maternal and newborn outcomes. 340 CHPS were trained on MNH modules through a trainer of trainers model and provided bicycles for enhanced mobility during household visits. This model increased new household visits up by 76%, pregnant women counselled on ANC more than doubled and referrals to health facility from 918 to 2,253 from 2023 to 2024. Fourth ANC coverage rose from 34.2% to 42.2% and full immunization rates from 74.9% to 84.2%. Recognizing these gains, the county government committed resources to expand bicycle provision for another sub county. This scalable model highlights the impact of combining technical training with enhanced mobility in strengthening community based MNH services in rural Kenya.