Management Sciences for Health's Communities of Practice working to reduce maternal mortality in Tigray, Ethiopia

Jul 2, 2015 by Mebrahtu Abraha Comments (0)

Management Sciences for Health's Communities of Practice working to reduce maternal mortality in Tigray, Ethiopia

By Mebrahtu Abraha

MSH Communities of PracticeMy home region of Tigray in northern Ethiopia has made great strides in ending preventable maternal mortality. Best estimates suggest that the maternal mortality ratio in our region dropped from approximately 653 maternal deaths per 100,000 live births in 1990 to 267 in 2014.[1] However, while most pregnant women in Tigray attend at least one antenatal care visit, only 41 percent attend the recommended four visits and less than 63 percent deliver with a skilled birth attendant.

We are always looking for new approaches to support the Government of Ethiopia’s effort to improve maternal health. One such approach is through communities of practice (COP), which we at Management Sciences for Health (MSH) call technical exchange networks. COPs enable MSH staff to learn, share knowledge, and improve the quality of project implementation. COPs follow educational theorist Etienne Wenger’s vision of a community of practice: “A group of people who share a common concern, set of problems or passion about a topic, and who deepen their knowledge/expertise in this area by interacting on an ongoing basis."

MSH created COPs in 2009 as a platform for employees who work around the world on different projects and in various departments to ask and answer technical questions and learn from our collective expertise and experience. COPs provide a way for technical staff to share information, project experiences, notes from technical meetings and working groups, announcements about upcoming events and webinars, and technical updates from organizations such as the United States Agency for International Development (USAID) and World Health Organization.

COPs have a virtual, asynchronous component in email distribution lists and a live, synchronous component in technical webinars organized for MSH staff.  Any COP member can initiate a discussion thread by emailing other members through the COP distribution list or can respond to a discussion thread started by another COP member. When it becomes apparent that a discussion topic has broad interest, as evidenced by many COP members posting comments, one or more staff are invited to present the information in a webinar.

MSH has COPs for many of our health systems and technical health areas, including a maternal, newborn, and child health (MNCH) COP. Members include MSH field and home office staff, ranging from technical experts in MNCH to colleagues who have little MNCH experience but want to learn more.

Five films for community health workers and nurses were circulated through the MNCH COP. The films were: Warning Signs in Pregnancy, Management of Postpartum Hemorrhage, How to Care for a Newborn, Steps to a Normal Delivery, and Focused Antenatal Care. As the regional technical manager for the recently completed Ethiopia Network for HIV/AIDS Treatment, Care, and Support (ENHAT CS) program, funded by USAID, I shared these films with all the stakeholder representatives in our region. The films were translated into Amharic, which is spoken in Tigray; are delivered in simple language; and target the major causes of maternal mortality and early neonatal death. The Jhpiego regional manager noted that the films were useful for helping frontline health workers refresh their skills.

At a meeting of the Regional Health Partners Consultative Committee we discussed a plan to disseminate these films to midwives through the Regional Health Bureau MNCH case team coordinator to ensure that all 52 district health offices in Tigray have a copy. As a result, midwives and health care workers in all 224 public health centers and three clinics of a local nonprofit, the Family Guidance Association, now use these films to refresh the knowledge and skills of their health providers. Our next step is to target health extension workers who will be able to view the films at health centers and take a copy home for future viewing.

MSH is proud to collaborate with the Government of Ethiopia and USAID to improve maternal health. The distribution of these films is one way that information and resource-sharing through COPs can help my country come one step closer to achieving our collective vision of ending preventable maternal mortality.

Mebrahtu Abraha served as regional technical manager for the Ethiopia Network for HIV/AIDS Treatment, Care, and Support (ENHAT-CS) program

Sara A. Holtz, MNCH technical advisor for Management Sciences for Health (MSH), contributed to this report

CLA in Action articles are intended to paint a more detailed picture of what collaborating, learning, and adapting (CLA) looks like in practice. Unlike other disciplines, CLA is not a technical "fix;" it looks different in different contexts. This series will showcase examples of intentional collaboration, systematic learning, and resourced adaptation, some of which you may find applicable to your own work. The case studies, blogs, and resources represented in this series document the real-world experiences of development practitioners experimenting with these approaches for the benefit of sharing what's possible. 

[1] Hagos Godefay, Peter Byass, John Kinsman, and Afework Mulugeta. Understanding maternal mortality from top–down and bottom–up perspectives: Case of Tigray Region, Ethiopia. J Glob Health. 2015 Jun; 5(1): 010404.