Integration of mother and child health services in Ethiopia

Abstract

In Wollo region of Ethiopia, various non-governmental officers have been working closely with each other and with the Regional Health Department to implement the policy of daily integrated mother and child health services. The record cards, registers, procedures and training courses of the separate 'vertically' organized services were brought together to enable the development of a model integrated service. There were improvements in accessibility, acceptability and output of the services. The system was evaluated by a joint Ministry of Health and UNICEF team, and was adopted for use in the rest of Ethiopia.

PIP: Maternal-child health services in the Wollo region of Ethiopia, south of Eritrea and Tigray, were reorganized into an integrated format by several non-governmental health officers in 1987-1988, replacing separate clinics and service records. Originally mothers had to attend on separate days for curative care, growth monitoring, vaccination, antenatal care and family planning. As a result they rarely came except for curative care. Daily integrated clinics were held combining growth monitoring, nutrition, prenatal or postnatal care, vaccination, family planning and health education, starting with the presenting problem and going through the other services. 5 patient registers and 11 record cards were replaced by 3 attendance and clinic records, 3 medical records, and patient identification and take-home cards. Staff were trained in use of oral contraceptive and prenatal check lists, vaccination graphs, and maintenance of sterilizers and refrigerators. An integrated check-list was made up for supervision and inventory supplies. After the new program was instituted, attendance increased and clients more readily accepted vaccination and oral contraceptives. Nevertheless, health workers later generally did not offer prenatal care unless requested, because there were few referral services available. Other problems with the system were staff difficulty in interpreting growth monitoring graphs and failure to record services rendered on new forms. This integrated system was extended to the remaining 9 districts in Wollo in 1988. In 1989 11 district courses were conducted to train 420 new staff.