This study examined the factors that influence the use of maternal healthcare services in Ethiopia and particularly assessed the use of antenatal and delivery-care services. Data for the study were drawn from the 2000 Ethiopia Demographic and Health Survey. Multivariate logistic regression analysis was employed to explore the relative importance of a number of demographic and sociocultural variables in the likelihood of using these services. Results of the study showed that the coverage of maternity-care services was very low in Ethiopia, i.e. about 27% and 6% of women, respectively, received professionally-assisted antenatal and delivery-care services in the five years preceding the survey. The study also revealed that demographic and sociocultural factors were the most important aspects that influenced the use of maternal healthcare services in Ethiopia. The independent factors influencing the use of maternal healthcare services included education of mothers, marital status, place of residence, parity, and religion. However, this cannot detract from the relevance of servicerelated factors, especially in the rural areas of the country.

Factors Influencing the Use of Maternal Healthcare Services in Ethiopia

This book considers the topic of scaling up focusing on ways to increase the impact of health service innovations that have been tested in pilot or experimental projects so as to benefit more people and to foster policy and programme development on a lasting sustainable basis. It addresses a major failure in the global health and development field: namely the failure to expand the many successful small-scale pilot or demonstration projects that have been organized around the world so as to benefit larger populations than those initially served. It presents a conceptual framework for thinking about scaling up as well as case-studies from Africa Asia and Latin America where the potential for expansion was a concern from the very inception of pilot or experimental projects. The case-studies discuss family planning and related reproductive health service interventions as well as other innovations in primary health care. Chapter 1 provides a conceptual framework for thinking about the scaling-up process within a systems context. The framework is informed by the literature of several disciplines and seeks to promote an interdisciplinary perspective on the topic. Chapter 2 describes the process of scaling up the introduction of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) while improving quality of care for all contraceptive methods in Viet Nams national family planning programme.Chapter 3 discusses the quality of care reform in China which seeks to focus the family planning programme on client needs informed choice of contraceptives and better quality services. The discussion in Chapter 4 moves to Zambia reporting on a project that initially field-tested a package of activities to support service delivery in three rural health districts of the Copperbelt Province. The project strengthened contraceptive choice developed referral systems for methods not available on site and applied innovative approaches to provider training. Chapters 5 and 6 are about the Community-based Health Planning and Services (CHPS) initiative in Ghana which has successfully replicated within the national health programme the experimental service delivery innovations developed and tested by the Navrongo Health Research Centre in northern Ghana. The two final chapters (7 and 8) discuss scaling up related to the Reprolatina Project in Latin America. This project sought to expand service innovations and participatory approaches pioneered in connection with the Strategic Approach in Brazil to other municipalities in that country and to Bolivia and Chile. Chapter 7 focuses on Brazil addressing the question of what has been learned about sustainable scaling up in resource-constrained decentralized public sector settings while Chapter 8 describes an innovative training and educational methodology applied in Bolivia Brazil and Chile as the means of scaling up technical and managerial improvements in the public sector. (excerpt)

Scaling up Health Service Delivery: From Pilot Innovations to Policies and Programmes

Background
Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain.

https://link.springer.com/content/pdf/10.1186%2F1472-6963-6-89.pdf

The cost of health professionals' brain drain in Kenya

In Ethiopia the levels of maternal and infant mortality and morbidity are among the highest in the world. The maternal mortality rate in 2000 was 816 per 100000 live births and the infant mortality rate was 113 per 1000. One explanation for poor health outcomes among women and children is the nonuse of modern health care services by a sizable proportion of women in Ethiopia. Previous studies have clearly demonstrated that the utilization of available maternal health services is very low in the country. Several studies in the 1990s have shown that about 25 percent of Ethiopian women received antenatal care and less than 10 percent received professionally assisted delivery care. Despite the fact that maternal health care utilization is essential for further improvement of maternal and child health little is known about the current magnitude of use and factors influencing the use of these services in Ethiopia. This paper therefore aims to fill this gap using data from the 2000 Ethiopia Demographic and Health Survey (DHS). The purpose of this study is to understand the current status of utilization of maternal health services in Ethiopia by elucidating the various factors influencing the use of these services in the country. It is hoped that the results of the study will improve policymakers’ understanding of the determinants of maternal and child mortality and morbidity in the country and serve as an important tool for any possible intervention aimed at improving the low utilization of maternity care services in the country. (excerpt)

Utilization of maternal health care services in Ethiopia

Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania. A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task. We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.

/pdf/human-resources-for-health-care-delivery-in-tanzania-a-20ppqbbg8y.pdf

Human resources for health care delivery in Tanzania: a multifaceted problem

This book reviews positive experiments in improving health care in sub-Saharan Africa and argues that despite existing resource constraints it is possible to make immense improvements in health care in the region at a cost of approximately $13/person (the current average expenditure is approximately $14/person ranging $10-100/person). These improvements will rely on 1) improving the capability of households and communities to respond effectively to health problems 2) reforming health care systems to use available human and financial resources more productively 3) providing cost-effective packages of basic health services and 4) incorporating cost-sharing to delivery basic health services to low-income areas. The first chapter contains an introduction and overview to the problem. Chapter 2 describes the conditions affecting health in the region and the economic cost of the situation. The third chapter discusses creation of an enabling environment for health and chapter 4 looks at revitalizing national health care systems. Chapter 5 explains the importance of pharmaceuticals and essential drug programs while chapter 6 considers management of human resources for health. Chapter 7 cover infrastructure and equipment needs and chapter 8 looks at management capacity and institutional reform. The next two chapter consider factors relating to costs and funding and the final chapter offers a timetable for change.

Elmendorf Ae

Papers

Better Health in Africa: Experience and Lessons Learned