Problem

In Arsi, Ethiopia, as high as 30% of births take place at home without the supervision of a skilled health worker. The low uptake of facility-based maternal health services by women living in hard-to-reach areas has been associated with high maternal mortality and morbidity in Ethiopia: the majority of maternal and neonatal deaths in Arsi Zone occur at home, due to lack of basic health care. From a demand-side perspective, barriers that hinder uptake of in-facility maternal health services include cultural preference to births in traditional surroundings, financial costs, lack of transport, negative perception of the formal health care system, lack of privacy, poor hygiene, lack of basic necessities such as water and food, and in some instances, inhospitable health professionals. Ethiopia’s Ministry of Health has under¬taken a number of important public health initiatives geared towards improving the uptake of facility-based maternal health services. Maternity Waiting Homes are part of the wide range of new services introduced by the Ethiopian Government in its efforts to improve timely access to skilled birth attendance and emergency obstetric care, particularly for women in rural and remote areas. A Maternity Waiting Home is a small residential corner in a health centre where women from remote areas as well as women facing risks that can be managed at health centre level (such as hypertension and anaemia) can wait for the onset of labour. Typically, a Maternity Waiting Home is composed of a single room with 3 to 5 beds and a separate kitchen. The establishment of such waiting areas enables more women from isolated areas and/or at-risk pregnant women to access birthing facilities on time, 3 to 4 weeks prior they due date, thus reducing health risks. However Maternity Waiting Homes are not currently functioning at full capacity in most parts of Arsi, including in the 4 health centres of Lode Hetosa District. Though they were originally designed to replicate a home-like environment to bridge the divide between institutional and home deliveries, the Waiting Homes in Ligaba, Kusligna, Hurutta and Lode Jimatta health centres are poorly furnished, lacking privacy and basic necessities such as hygiene items and food. The added value of these Waiting Homes is currently being less and less appreciated by women from Lode Hetosa District who feel that the complexes do not meet their needs during pregnancy. As such, though Maternity Waiting Homes constitute a relevant option in areas with limited access to emergency obstetric care such as Arsi Zone, the uptake of the service remains insignificant in Lode Hetosa District. We strongly believe that by upgrading the standard of the Maternity Waiting Homes and making the beneficiaries feel at home, it would be possible to increase the utilization of the services, thus averting preventable maternal and neonatal deaths.

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