Work plans 2012-13

In August 2012 we started Phase II of the RMM work. The aim of the RMM programme is to reduce maternal and neonatal deaths in Segen Zone, Gamo Gofa Zone and in Basketto Special woreda.

During the first phase (2008 – 2011), we focussed on setting up institutions doing Comprehensive Emergency Obstetric care (CEmOC). While Arba Minch Hospital served as the main centre for training, Gidole, Saula and Chencha hospitals, and Konso, Kemba, Basketto and Melo Health Centres started to do caesarean sections through support by our project.

All these institutions are regularly doing caesarean. The challenge is the large populations living in the Gamo and in the Gofa highlands, in the remote Konso areas and in Aliy still have limited access to such services. This is the main challenge of the RMM Phase II project.

During the second phase (2012 – 2016) we aim to increase the coverage of Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CemOC). We will set up five new CEmOC places in Kolme, Gawada, Gezzeso, and Beto and in Selam Berr (Kucha). We shall also do some work to improve the access by enabling other health centres to do BEmOC, and link the work at these health centres both to health posts in the kebeles, and to improve referrals to institutions doing CEmOC.

For this work we have now one Ethiopian coordinator in each of the zones. The coordinators shall manage the daily work, and visit and support the hospitals and health centres.

Arba Minch Hospital

Training Unit: The hospital works well as a training site for our project. Currently staffs from Kolme, Saula, Kucha and Chencha are being trained.

Blood Bank: The hospital has a well-functioning blood bank. This blood bank will serve as a training site for the hospitals in Gidole, Saula and Jinka.

Neonatal Intensive Care Unit: The hospital has recently opened such a unit. Three nurses have been trained in Addis Ababa, and three more nurses will go to Addis soon for training. The RMM project supports this unit with some equipment, in 2013; the unit will train similar staff from Gidole and Saula Hospitals.

Arba Minch University and Master programme in Integrated Emergency Surgery
Our aim is to support the Master programme in Integrated Emergency Surgery (Obstetrics, gynaecology and general surgery). There have been some delays in the start of the three-year course. Arba Minch University has now told us that they expect this training to start in two-months.

Improving quality of midwife training
We have started work to improve training students at the Midwife school at the Health Science College in Arba Minch. Particular attention is on enabling the students to aquire the necessary skills to do their work at remote health institutions.

Saula Hospital
The hospital works well. The number of deliveries has increased from about 50 four years ago, to 498 during the last year. They did about 140 CS. This is a great improvement, and shows that focused supervision and support can improve essential delivery services.

Blood Bank: The hospital has set aside two rooms to set up a blood bank. We shall order equipment and laboratory instruments, train staff, and we plan to start the blood bank in early 2013.

Neonatal Intensive Care Unit: The hospital has recently opened such a unit. In 2013, the unit will train similar staff from Gidole and Saula Hospitals.

Training at Saula Hospital: Saula Hospital has this month managed to employ a gynaecologist with experience in training health officers for emergency obstetrics. This is a great opportunity to strengthen the capacity at the hospital, and for the Gofa area (population almost one million). We will therefore start to train two health officers in emergency obstetrics in Saula.

Gidole Hospital
Gidole Hospital works well. A health officer who completed the masters in emergency obstetrics and surgery now also staffs the hospital. He was the first health officer who started operations in Gidole in 2008. He does emergency obstetrics, and some basic surgery, and the work is good.

Blood Bank: Gidole Hospital has rooms for a blood bank. They also have laboratory technicians that will receive training in Arba Minch. This work is scheduled for 2013.

Neonatal Unit: This unit shall train HEW and staff from health centres to do neonatal resuscitations. The hospital has set aside a room for this purpose. We have bought some equipment for this purpose.

Training Centre: The health centre needs some teaching materials. We have bought some training models from the Laerdal Foundation, and we shall buy some more equipment in the coming month.

Training of staff at Gidole Hospital: We shall also start to train nurses from health centres and health extension workers in Gidole (see community work). This is to give them practical training and aquire skills.

Chencha Hospital
This hospital continues to do CS regularly. Unfortunately, the work has not increased during the last years. Chencha hospital serves a large catchment population (about 400.000 people). These are concerns we shall address in the coming year.

Konso Health Centre
Konso Health Centre works well. From a problematic start in 2010, it has increased the number of yearly deliveries from about 100 to 480 last year (Ethiopian calendar 2004). Last year they did 42 caesarean Sections, without major complications. They referred some patients with severe anaemia and with uterus ruptures to Arba Minch Hospital. The health officers Tamiru and Etenesh are doing very good work, and they are eager to help expanding this work to other areas in Konso woreda. Tamiru has agreed to take part in supervising Arfaide HC.

The government plans to finish the new hospital in Konso in August 2013. They will then move the delivery services to the new delivery and operations wards. The RRM project plans to build a maternity waiting area at the new hospital, and we hope this will be ready to begin the new hospital. RMM will provide the new hospital with some more equipment, and we plan to start a blood bank.

Kolme Health Centre
The Kolme Health Centre has now been opened. As outlined in our plan, we started training a health officer to emergency surgery, a nurse for short-term training in anaesthesia, and a scrub nurse. We shall now buy the necessary equipment, and hope to start operation in early 2013.

Gawada Health Centre
This new health centre is now almost complete, and work will start in 2013. Meanwhile, we will support the start of the new delivery services at this HC.

Kemba, Basketto and Melo Health Centres
We started work at these health centres during the first phase of RMM. They function well, and Melo HC, the institution furthest away, is doing a good job. In two years they have done over 70 Caesarean Sections, and the number of deliveries is steadily increasing. Their good performance is of such a good quality that it merits consideration to expand the work and include a remote health centre and thus improve the referrals We will consider starting this in 2013.

Selam Berr (Kucha) Health Centre
We started planning for this work in 2011. Unfortunately, the building work was delayed, and this delayed the start. We have now started to train staff from the health centre, and hope to start operation in early 2013. A new hospital is being built near to the health centre, and the delivery services at the health centre will move to new buildings when the hospital starts in about one year.

Beto Health Centre
Beto is located about 80 km south of Saula, and near to the mountains north of Jinka. The catchment population are about 150.000 people, and include people from Beto woreda, the southern part of Zala woreda and six kebeles of Maale woreda in the South Omo Zone.

There is a clear need to improve the delivery services in this remote area. The woreda is supportive, and the health centre has a building with four rooms suitable for such a unit. The health centre has 24-hour electricity, good water supply, and a standby generator. The head of the health centre is a health officer, with many years of working experience from the operation theatre at Arba Minch Hospital.

Beto is in our 2013 plans, and we shall now start to train one health officer, one anaesthetist nurse, and one scrub nurse. We shall also buy equipment, and we hope to start operations in early 2013.

Gezzeso Health Centre
Our birth registration suggests the maternal mortality rate is high in the Gamo Highlands. The main reason for this is thought to be that this mountainous areas, with mountains above 4000 m has a high population density, and inaccessible by road. Gezzeso HC is located at the heart of this area. The HC has good water supply, a good building, a generator and solar electric supply, and enough staff. The catchment population is about 150.000 people, and include people from Bonke Kemba, Dita, and Arba Minch Zuria woredas. Gezzeso is in our 2014 plan, but we will try to include the start of this much needed work in 2013, and training of staff will start in March 2013.

Use of Birth registries
I have analysed the birth registries so far, altogether about 26000 births during the last three years. Unfortunately, some births in the last six months have not yet been entered our database, especially from Bonke and Gidole. With these limits, I believe that our data suggest some interesting findings:

The maternal mortality has decreased during the last three years. The trend is significant, but varies between the woredas.

The decline in MMR seems to be associated with the availability of delivery services in the woreda (coverage and accessibility). This is agrees with our earlier study on the performance of health centres and hospitals. The largest decline is in Gidole and in Demba Gofa (Saula). These are also the two woredas with the highest CS rates per population.

Community programme
Our aim is to reduce maternal and neonatal deaths, and stillbirths. Thus we need to increase and strengthen institutional delivery services, and improve referrals to the hospital. We aim to strengthen the delivery services and referrals at about 20 kebeles in Dirashe and Aliy woredas and at five health centres. We shall start with the Gato HC.

Gato Health Centre and five health posts: Gato Health Centre has a population of about 31000 people. There are four kebeles (Gato, Shillale, Ataya and Kolla Mashille) that refer patients to this health centre. The number of deliveries at this HC has increased much during the last year. They have now agreed to use all designated delivery rooms. The RMM Segen project has received an invitation from the Dirashe woreda to facilitate talks between health extension workers and traditional birth attendants. We would be happy to facilitate such talks, and see this as a possibility to strengthen institutional deliveries. We have also bought a motorcycle ambulance (see for Gato health centre. From this work we hope to learn more on how we can expand this work to the other health centres and health posts in the woreda.

Arfaide Health centre: This HC has a catchment population of 34000 people. Six kebeles (Lehaite, Tishmale, Galabo, Kemale, Gunjera and Osho) refer patients to this HC. The HC has one midwife, and several nurses that have received BEmOC training. They lack some practical training, and the HC lacks some essential equipment. We have agreed that the HC shall clear the necessary rooms for this work. We have also bought a motorcycle ambulance for Arfaide health centre.

Community programme at Loote HC: Loote Health Centre in Demba Gofa woreda near to Saula has a catchment population of about 34000 people. There are nine kebeles that refer patients to this health centre. The number of deliveries at this HC is about 5-8 each month. The infrastructure is good, but the HC needs some extra equipment and supervision. We have bought a motorcycle ambulance (see for Loote health centre. The distance to Saula Hospital is 18 km, and the road is good gravel road. We shall evaluate the work after some months, and evaluate if we can expand it to include health posts in the area.