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Delays cause maternal deaths in rural Ethiopia

In rural areas, the inability to get to a health centre or hospital is a major factor in women not accessing skilled delivery care.  In Ethiopia, only 6% of women will give birth in a medical institution. Transport problems, the cost of getting to a health centre, and the inconvenience or travelling are among the major causes for women not getting the medical care they need.

Borena woreda in South Wollo zone is  one of the most isolated areas in Ethiopia due to its rugged highland landscapes. The only transport available is a bus that arrives once a day from Addis Abbaba and once from Dessie, a zonal town.

During a recent field trip to the area, I witnessed the tragic death of a pregnant woman, Habtam Mengiste. The 35-year-old woman from Beta village, traveled 2 hours from her house, carried on a stretcher, to reach the center of the village.

The health officer who attended Habtam diagnosed her with antipartum haemorrhage and decided that she needed special care and attention at the next higher referral hospital in Dessie, which is 180 km from the district health center. She didn’t reach the facility on time. She died on the way there.

Save the Children UK has been working in the Borena district for over 10 years to improve the access and quality of maternal, newborn and child health services. Towards the end of a five year European Union funded project in 2005, we adapted a project vehicle to act as an ambulance for the district.

As a result of high community demand and detailed community discussion, the district administration and the community agreed to maintain the ambulance by adding 3 Birr (Ethiopian currency) per year per household on the annual land tax.  The ambulance is expected to serve 36 farmers associations in the district (which has 165,000 people). During the last four years the ambulance served 2,693 peoples, 1,777 of whom were  pregnant mothers.

The ambulance has been used extensively since its introduction and there is still a strong sense of joint community and health centre ownership.  It is well maintained and operates a 24 hours service.  The ambulance is still unable to reach all the households in Borena district as some are only accessible by foot.  In these cases, patients have to walk some way to be picked up by the ambulance on an accessible road.

In addition, although community satellite phones exist, households still find it difficult to call an ambulance to their home. They often still go to the health centre on foot to request an ambulance for the sick patient.  This has resulted in most of the referrals being from the health centre to the hospital as opposed to from households to the health centre, which would be more direct and rapid.  This may change as mobile phone coverage increases in the area.

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