Maternity waiting homes in Ethiopia--three decades experience

Abstract

Background: Access to comprehensive emergency obstetric care is limited in Ethiopia. Maternity waiting homes are part of the strategies utilized to improve access to hard to reach rural populations. Despite long years of existence of this service in Ethiopia, the practice has not been adequately assessed so far.

Objectives: Describe the current status of maternity waiting home services in Ethiopia

Methods: All facilities in Ethiopia that have a maternity waiting home were identified from FMOH data as well as personal contacts with focal persons at Regional Health Bureaus in the nine regions and UNICEF regional offices. A standardized data collection tool for facility assessment was developed by the quality referral team, Health Section, UNICEF. Data collection included site visits and documentation of infrastructural related issues through a facility checklist. Service related issues were also collected from log books and other documents as well as through interview with relevant staff Focus group discussions were held with all MWHs attendants who were found admitted at the time of the review at Attat, Wolisso and Gidole hospital maternity waiting homes on major thematic areas identified by the review team regarding MWH care

Results: The practice of maternity waiting homes in Ethiopia spans more than three decades. Nine facilities located in five Regional States had maternity waiting home services. All except one were located in hospitals. Admission capacity ranged from 4 up to 44 mothers at a time. Seven of the maternity waiting homes required the clients to cater for their own food, firewood and clothing supply providing only kitchen space and few kitchen utensils. Clients came from as far as 400 kms away to obtain services. Medical care and documentation of services were not standardized Duration of stay varied from 3-90 days. Monthly admission rates varied from 0-84 mothers at different institutions. Major indications for admission were previous caesarean section 34%; previous fistula repair 12%; multiple pregnancy 12% and malpresentations 8% Indications for admission were not standardized and not medically clear in some instances. There were indirect evidences that the service improved maternal health outcome while caesarean sections rates were much higher among clients' admitted to maternity waiting homes compared to non-users.

Conclusions: Provided that maternity waiting home service is standardized and institutionalized it can be one approach to improving access to comprehensive emergency obstetric care for rural mothers in Ethiopia who are challenged by distance to access services.

Recommendations: There is a need to standardize indications for admission to maternity waiting homes as well as formalize the semi-institutionalized care being provided at these facilities at present. Benefits towards better maternal and neonatal outcome as well as cost effectiveness of care should be documented through further analytic studies.