MNH ECohorts to track longitudinal maternal and newborn health quality: Experiences from the pilot in Ethiopia

Abstract

A woman dies every two minutes due to pregnancy or childbirth. In 2020, there were an estimated 287,000 maternal deaths, 70% of them in sub-Saharan Africa. Despite reductions in maternal mortality throughout the early parts of the twenty-first century, much progress that was made has stalled, and in some places reversed. (1) This mortality reflects poor-quality care enabled by poor quality health systems. Health system failures contribute to poor health outcomes by fostering delays in care seeking, delivering poor quality care, having shortages of essential foundations of the health system, and by being a system that isn’t accountable to the people who use it. A key component of high-quality health systems, and a critical link between the foundations of health systems that deliver care and improved health outcomes, are processes of care: competent care and systems, and a positive user experience. The MNH ECohort fills important gaps in understanding health systems through the lens of the Lancet Global Health Commission on High Quality Health Systems framework by including existing and validated survey questions from existing instruments, as well as newly developed items according to the five key domains of the framework: competent care and systems, user experience, health outcomes, confidence, and economic benefits. (2) This doctoral project will focus on the key activities for the implementation of the ECohort in Ethiopia, including survey adaptation, piloting of the tool for the first time, and reflections on policy uptake pathways for data generated by the MNH ECohorts in Ethiopia. The compressed pilot of the MNH ECohort in Ethiopia took place from 27 January-6 March, 2023 and enrolled 119 women, 59 at their first ANC visit, and 60 immediately after delivery at six health facilities in Bishoftu town and East Shewa, Ethiopia. Of the 59 women enrolled at ANC, 44 were contacted three weeks later and asked about additional ANC they received since enrollment. Of the 60 women enrolled at delivery, 45 were contacted two weeks later to complete the module on intrapartum care, and 20 women were contacted two weeks after that for an in person endline survey asking about postnatal care. A key finding regarding the implementation of the MNH ECohort in Ethiopia is that careful programming of this complex tool is essential for successful implementation. Despite challenges with the data, early indications from this approach suggest rich and useful findings regarding health system performance for improved maternal and newborn health in Ethiopia. Of the 60 women enrolled at baseline, content of care for the first ANC visit is high, but diminution exists in additional care: 96.9% of women have a blood pressure measurement at ANC1, and only 50% of women have a blood pressure measurement at ANC2. If trends like this persist in the mainstage, there will be actionable findings for the Ministry of Health in Ethiopia to improve retention in the MNH continuum of care. The contributions of the MNH ECohort to the understanding about health system performance and competence will inform policy making and programming aimed at improving retention in essential health care services for improving maternal and newborn health outcomes.