Three step model: Early care seeking and referral solutions to improve effective care-seeking and response for critical maternal and newborn health in Ethiopia

Introduction: Ethiopia is one of the countries with high maternal (676/100,000 LB) and newborn (37/1000 LB) mortality according to EDHS 2011. While access to high impact maternal and newborn interventions has improved with the launching of training of accelerated midwives and health care providers on basic emergency obstetric and newborn care, low care seeking behavior and weak referral system remain a big challenge with services lacking referral protocols, standard use of ambulances, feedback, poor coordination and communication among stakeholders and sub-standard supportive supervision.

Description of the Program: As part of the Bill and Melinda Gates Foundation-funded, Last Ten Kilometers (L10K) project, Early care seeking and referral solutions a three step model was implemented in 16 primary health care unit with a goal to improve effective care-seeking and response for critical maternal and newborn health conditions through consultation with community, health care providers, district health office and administration.  

Three step models is an approach in which referral resources were mapped to identify barriers for functional referral system, design referral system models and implement active referral management.

 Results and Lessons learnt: The process led to improvements in early identification of pregnant women, utilization of referral protocols, improved supportive supervision, communication and coordination among sectors.    Moreover,   community local group ‘edir’ takes initiatives to give loan for pregnant women that cover the expenses of delivery and related fees.

As a result proportion of antenatal care, delivery, referrals, referral slip use, proportion of ambulance use, and feedback improved significantly.  Moreover, it ensures ownership and sustainability.