How information recasts a problem into a local innovative solution

In Ethiopia’s West Azernet Berbere woreda of the Silte zone, health workers were puzzled. A mother, who had faithfully shown up at one of the woreda’s health centers for all her antenatal care (ANC), missed her delivery appointment and instead, gave birth at home. The health workers providing her care reported the strange case.

Shukureto Ababiya, the Woreda Health Office (WorHo) head, took the report seriously and reviewed the woman’s information and history. He discovered that she had not missed any appointments during her pregnancy care and that she gave birth to her first child in the health center. Shukureto visited the mother to ask her directly why she chose a home birth.  Her response was unexpected.

After the birth of her first child at the healthcare center, the vehicle drivers ridiculed and belittled her because her outfit was spotted with stains. “I didn’t want to go through the same experience,” she told Shukureto. “But I can’t afford to rent the vehicle also. I decided to give birth at home though I’m aware of its downsides.”

It was a stunning revelation for Shukureto- the health workers had not thought that one unrelated action could hamper the success of their months-long work. This realization forced the woreda to assess if this one mother’s story could be also applied to other mothers.

Entrance to the health center. Photo: Benti Ejeta, JSI
“I didn’t want to go through the same experience. But I can’t afford to rent the vehicle also. I decided to give birth at home, though I’m aware of its downsides.” -A mother in West Azernet Berbere woreda

The Practice

While there is a government provided ambulance to serve patients in the area, the enormous demand for transportation often leaves new mothers to arrange for their own transportation, post-delivery. Women can either rent a Bajaj (a three-wheeled vehicle that transports three to five people at a time) for the day or take a public transport.

The daily rental price of a Bajaj is conservatively around 350 Birr- far too expensive for the mothers. Thus, the viable option for most women is public transport, but for many, it is an unpleasant experience of verbal mistreatment and a weary trek (passengers are dropped off far from their actual destination).

A pregnant mother receiving care at the health center. Photo: Benti Ejeta, JSI

Disconcerting reports of mothers’ experiences with transportation had appeared repeatedly, but informally. From the woreda review, the lack of transportation was concretely found to be one of the demotivating factors for women to come to the health center for delivery. With information to inform a solution, the health staff used the incident to mobilize for change.

The viable option for most women is public transport, but for many, it is an unpleasant experience of verbal mistreatment and a weary trek.

The Solution

The Mugo Health Center, which leads one of the health clusters of the woreda, was among the first to act swiftly. In November 2018, Mugo Health Center organized a town hall meeting. What initially intended to be an awareness-raising opportunity suddenly transformed into a full-fledged fundraiser, as participants astonishingly raised more than the targeted amount. On the spot, Mugo Health Center was able to raise enough funds to purchase a Bajaj, and with a small add up, a minibus. “When we got the bus, we will be able to address the problem transportation related to referrals to Hospitals,” says Abdulfata Mohamed, head of the health center.

Part of the solution was also to convince Bajaj owners to support the initiative. The response of the Bajaj owners and drivers was very positive. About eight Bajaj owners enthusiastically joined the initiative in the Mugo Health Cluster and volunteered to transport a mother each month. In the process, they earned the honorary name, the Ambassadors of Mothers.

Abdulfatta, Head of Health Center. Photo: Benti Ejeta

A little less than six months since its inception, the Ambassadors of Mothers have provided 496 transportation services in the Mugo Health Cluster alone, according to Abdulfata. Mulu Birhan who works with the health center in raising awareness says, “These Bajajs are our ambulances. They are always at our disposal regardless of when they are called on.”

Samira Wabarabi, Health Extension Worker at Mehal Mugo Health Post, one of the health posts under Mugo Health Center, notes the positive effects that the Ambassadors of Mothers have had. “The inflow of mothers giving birth at the health facility has increased since then. Our work is greatly benefiting from this initiative,” says Samira. “We stopped worrying whether a mother will show up for the delivery or not.”

"Our work is greatly benefiting from this initiative. We stopped worrying whether a mother will show up for the delivery or not.” -Samira Wabarabi, Health Extension Worker

Hashim Shukurela, one of the Ambassadors at Mugo Health Cluster and the leader of his team, says he feels “great relief” even if it means his two kids occasionally sacrifice bread. He notes the resounding demand and intends to convince others to join the efforts. Abdulfata agrees with Hashim that more drivers/owners are needed. However, the health center needs to ensure that every driver is caring, respectful and compassionate when serving clients. “By joining the Ambassadors, drivers become part of us. What is expected of us is expected of them as well,” says Abdulfata.

Hashim Shukurela, leader of Ambassadors of Mothers at Mugo Health Center. Photo: Benti Ejeta, JSI

The Takeaway

Since its start, four Bajaus were purchased in the district, and many Bajaj owners joined the Ambassadors of Mothers. As a result, many more mothers are giving birth at healthcare units than before. The cumulative effect of this and other successes propelled the woreda to become one of the eight transformed woredas in Ethiopia.

From one unfortunate incident, the Woreda Health Office demonstrated that, if taken seriously and turned into a learning opportunity, an issue can become a springboard for effective, informed and innovative solutions that improve health outcomes and can be supported and fostered by the community.

Re-posted with permission from Ethiopia’s Federal Ministry of Health. Originally posted on June 18, 2019.

Cover photo: Benti Ejeta, JSI

About the Ethiopia Data Use Partnership
The Ethiopia Data Use Partnership (DUP) was established in 2016 as a collaborative endeavor of the Ethiopian Federal Ministry of Health (FMOH) to advance the country’s health information system.  With support from the Bill & Melinda Gates Foundation and Doris Duke Charitable Foundation, DUP provides technical assistance to improve the collection and use of high-quality routine health information, leading to better quality and availability of primary health and nutrition services at all levels of the health system.  Leveraging the synergy of partnerships, DUP also serves as an engagement platform for partners and donors and strives to galvanize additional commitments to strengthen the national health information system for increased and better use of data for action.

Under the direction of the FMOH, DUP is implemented by JSI Research & Training Institute, Inc. in collaboration with, Regenstrief Institute, and the University of Gondar.

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