Effective Referral System for the Utilization of Critical Maternal and Newborn Health at Rural Health Centers of Ethiopa

Access and utilization of proven interventions to reduce maternal and newborn death is low in Ethiopia; mainly due to socio-cultural factors, limited number of skilled staff, limited number of well equipped and well functioning facilities, low quality of care and weak referral system. L10K is implementing effective referral solutions to improve care-seeking and response for critical maternal and newborn conditions in 16 rural health centers of Ethiopia. The core interventions that L10K uses are a three step change process-1) assesses local context and available referral resources; and 2) use that information in the participatory design of innovations to strengthen the referral system; and 3) implement the active management of the referral system. A facility based baseline (March 2013) and follow-up (December 2014) data were collected to measure the effectiveness of the project. Descriptive and t-statistics were done to assess statistically significant differences in the outcome measures using Stata version 12.1. The mean score of adherence to referral protocols while referring (i.e., escorting, use of slip, use of ambulance, advance call and feedback) was significantly increased from 33% at baseline to 58% currently (P-value <0.01). The delivery coverage was increased from 24% to 37% (P-value<0.01). The percentage of the expected obstetric complications managed was also increased from 23% at baseline to 43% currently (P-value<0.01). The analysis also indicated that the adherence to referral protocols was significantly associated with the utilization of lifesaving interventions (P-value <0.01). Utilization of lifesaving obstetric interventions has improved following the implementation of the effective referral solutions.